Introduction. Fusion represents an effective treatment option in patients affected by end-stage arthritis. To minimise the risk of non-union following fusion, biological preparations such as bone marrow aspirate concentrate (BMAC) are commonly used intra-operatively. Mechanotransduction represents an emerging field of research whereby physical stimuli can be used to modulate the behaviour and differentiation of cells. Blast waves (a subtype of shock waves) are one such physical stimulus. The aim of this study was to investigate whether the osteogenic potential of BMAC can be enhanced using a blast wave, and thus improve its efficacy in
Lumbar
Purpose. The behavioural change wheel methodology and social cognitive theory were combined to inform and develop a rehabilitation programme following lumbar
Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterized by a Cobb angle of at least 10 degrees. The goal of surgery is to not only prevent progression but restore sagittal and coronal balance, protecting cardiopulmonary function and improving cosmesis. We reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcome(PROMs). The senior authors prospectively maintained database from 2003 –2022 was retrospectively analysed in terms of pre- and post-operative patient reported outcome measures (SRS 22) as well as radiological parameters. 44 patients with AIS were identified with pre and post op PROMS. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior surgery. There was a total improvement in SRS 22 scores by 7.8%. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 0.4 (p<0.001). However, no difference in function, pain and mental health were recorded. Overall, proximal thoracic (PT) curves improved from 24 degrees to 11 degrees (p<0.001), Main thoracic (MT) curve 55 degrees to 19 degrees and Thoracolumbar/Lumbar curves (TL/L) 45 degreesto 11 degrees. Pre-operative flexibility and post-operative correction were 0.40 and 0.41 respectively for PT curve. MT was 0.32 and 0.67. That for TL/L was 0.57 and 0.71 respectively. Surgery yields significant main curve correction correlating with high patient reported satisfaction rate. Although total SRS 22 score yielded 7.8% improvement, sub-analysis of self-image showed the most significant improvement.
Hemorrhage and transfusion requirements in spine surgery are common. This is especially true for thoracic and lumbar
The objective of this paper is to demonstrate the difference in post-operative complication rates between Computer-assisted surgery (CAS) and conventional techniques in spine surgery. Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CAS. Yet, few studies have compared the incidence of post-operative complications between CAS and conventional techniques. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between CAS and conventional techniques in spine surgery. Out of 15,222 patients, 14,382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had less odds to experience adverse events post-operatively (OR 0.57, P <0.001). This paper examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar
Purpose: Perispinal core muscle strength has been theorized to be an important component in the pathogenesis of back pain. Recent research has demonstrated a strong association between preoperative perispinal musculature, adjusted for fatty infiltration and prospective outcomes and improvements in back pain in patients undergoing lumbar laminectomy without fusion. The purpose of this study is to determine if a similar relationship exists in patients undergoing elective posterior lumbar fusion and decompression (PLFD) surgery. Method: A retrospective observational study of prospectively collected outcomes data was conducted in which pre-operative function and patient variables of those undergoing PLFD were derived from a functional status questionnaire and medical records. ImageJ Digital Imaging Software was utilized to measure the total (CSA) and percentage of fatty infiltration of the psoas, multifidus, and erector spinae muscles in pre-operative L4 axial CT images. Pre-operative and post-operative lateral images were evaluated for degree of post-operative adjacent level degeneration. Follow-up consisted of a functional status questionnaire. Outcomes measured were improvements in back pain, leg pain, and Oswestry disability scores. Results: Twenty-three patients were analyzed with a mean follow-up of 2 years (range 1 – 5 years). Outcomes improved following surgery. There were strong to moderate correlations between percentage of fat in the pre-operative posterior spinal muscles and improvements in leg pain (r = 0.63, p = <
0.001) and improvements in back pain (r = 0.41, p = 0.05). There was a moderate trend towards greater adjacent level degeneration (r = 0.37, p = 0.1) in patients with higher percentage of fat in the pre-operative posterior spinal muscles. There was a strong relationship between greater adjacent level degeneration and pre-operative disability as measured by the Oswestry (r = 0.62, p = 0.03). Conclusion: The results demonstrate that a potential relationship exists between pre-operative fatty infiltration of posterior perispinal muscles and post-operative outcomes, and adjacent level degeneration following lumbar
Failed fusions are difficult to treat. This is an analysis of a subgroup of 19 patients who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions. Out of 142 patients who received 181 lumbar disc replacements of two different models, 19 patients (11 men and eight women) had previously undergone posterolateral fusions of one or two lumbar segments. Seven of these patients had junctional replacement using a Charité disc prosthesis and 12 using a Centurion disc prosthesis. The mean age was 46 years (33 to 63). All patients had a significant flat back deformity of their lumbar spine before the index operation. All presented with sacro-iliac joint pain and 17 had spinal stenosis symptoms. The mean postoperative hospital stay was 3.4 days (2 to 8). All patients returned to their previous occupations at a mean of 29 days (21 to 42). Follow up ranges from 6 to 32 months. At the latest follow-up, 10 patients were very satisfied and nine were satisfied. The Oswestry score in the last 12 (Centurion) patients decreased from 49 ± 12 preoperatively to 16 ±22 at the latest follow-up. There are no published data on this particular subgroup of patients. They are difficult to treat and would otherwise require combined front and back procedures with extension of the fusion in order to correct the sagittal imbalance. Disc replacement seems to be a good salvage procedure for junctional failure after previous fusions.
A subgroup of nine patients, five women and four men, who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions (one or two levels) is reviewed. Two patients underwent double-level disc replacement. The mean age was 46.1 years (33 to 62). All patients had marked flattening of the lumbar spine before the operation. One patient developed subsidence within two weeks of the procedure but went on to a satisfactory result. One patient with a double-level disc replacement needed another operation because of a missed far out lateral disc. On day five after the procedure, the top-level disc was removed, the level properly decompressed and the disc reinserted, with good results. The mean postoperative hospital stay was 3.9 days (3 to 8). Within a mean time of 32 days (21 to 42), all patients returned to their previous occupations. Follow-up ranged from 3 to 19 months. At the latest follow-up, four of the patients were satisfied and five were very satisfied. Disc replacement seems an ideal salvage procedure for junctional failure after previous fusions. The short-term clinical results are good.
Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative spinal instability or nerve compression at the same level. The most common reason for early reoperation and late operation is sASD, therefore is in our best interest to understand the causes of ASD and make steps to limit the occurrence. Method. A comprehensive literature search was performed selecting Randomized controlled trials (RCTs) and retrospective or prospective studies published up to December 2023. Meta-analysis was performed on 38 studies that met the inclusion criteria and included data of clinical outcomes of patients who had degenerative disc disease, disc herniation, radiculopathy, and spondylolisthesis and underwent lumbar fusion or motion-preservation device surgery; and reported on the prevalence of ASD, sASD, reoperation rate, visual analogue score (VAS), and Oswestry disability index (ODI) improvement. Results. When compared to
Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, affecting 1–3% of the population. Most cases are treated conservatively. Curves exceeding 45° in the thoracic spine and 40° in the lumbar spine may require correction and
Intraoperative range of motion (ROM) radiographs are routinely taken during scaphoidectomy and four corner
Aims. We compared decompression alone to decompression with
Introduction. Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST. Methods. A review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/
Background and Purpose. The UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar
Spine surgery is common and costly. Researchers and policy makers believe that utilization of spine surgery in the US is significantly higher than in other industrialized countries. Although within-country variation in spine surgery utilization is well studied, there has been little exploration of variation in spine surgery between countries. We used population level administrative data from Ontario (years 2011–2015) and New York (2011–2014) to identify all adults who underwent inpatient spinal decompression or
Aims. Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine
Abstract. Objectives. to evaluate the efficacy and safety of topically applied tranexamic acid (TXA) in thoracolumbar spinal tuberculosis surgery, posterior approach. Methods. Thoracolumbar spine tuberculosis patients who requiring debridement, pedicle screw fixation and
Resident involvement in the operating room is a vital component of their medical education. Conflicting and limited research exists regarding the effects of surgical resident participation on spine surgery patient outcomes. Our objective was to determine the effect of resident involvement on surgery duration, length of hospital stay and 30-day post-operative complication rates. This study was a multicenter retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All anterior cervical or posterior lumbar
Introduction and Objective. Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) represent the most popular techniques in performing an interbody fusion amongst spine surgeons. Pseudarthrosis, cage migration, subsidence or infection can occur, with subsequent failed surgery, persistent pain and patient’ bad quality of life. The goal of revision