Luk (Luk et al. Spine vol 23(21) 2303-2307 1998) has shown that in posterior surgery, the correction achieved can be predicted by fulcrum bending films. The relevance to anterior correction has been disputed, as this commonly involves shortening the spine by the removal of intervertebral discs. The aim of the study was to see whether the pre-operative bending angle reflected the degree of correction achieved. 91 patients with a structural thoracic curve had an anterior endoscopic correction using a single rod. The mean age was 16.1 years. (range 10-46) The majority of curves were Lenke type 1 (79%) or Type 2 (8%). In all cases disc clearance and bone grafting were performed. All had pre-operative fulcrum bending films. The mean Cobb angle achieved at the pre-operative bending film was compared with the post-operative correction at 2 months. The FBCI (Fulcrum Bending Correction Index) and correction rates were also calculated. The FBCI is calculated by dividing the correction rate by the fulcrum flexibility and expressed as a percentage. It takes into account the pre-operative flexibility of the curve.Introduction
Method
1. To evaluate how radiological parameters change during the first 3 years following anterior endoscopic surgery. 2. To report complications encountered in this period. Between April 2000 and June 2006,106 patients underwent an anterior endoscopic instrumented fusion. There were 95 females and 11 males. Average age was 16.1 years (range 10-46). 103 (97%) had right-sided idiopathic curves. The majority were Lenke type 1 (79%). Patients were assessed at 3, 6, 12, 24, and 36 months. 83 patients had 1 year follow-up, 69 had 2 years or more. The following were investigated; the structural curve, instrumented curve, non-structural curves, skeletal age at operation and sagittal profile (T5-T12).Purpose
Methods
Following the publication of our original survey in 2000 (Eur. Sp. J. 11(6):515-8 2002) we have sought to re-evaluate the perceptions and attitudes towards spinal surgery of the current UK orthopaedic Specialist Registrars (SpRs), and to identify factors influencing an interest in spinal surgery. At that time 175 orthopaedic spinal surgeons in the UK needed to increase by 25% to satisfy parity with other European countries. A postal questionnaire was sent to all 917 SpRs. The questionnaire sought to identify perceptions in spinal surgery, levels of current training and practice, and intentions to pursue a career in spinal surgery.Introduction
Methods
This study investigates the effect of somatisation on results of lumbar surgery. Pre- and post-operative data of all primary discectomies and posterior lumbar decompressions were prospectively collected. Pain using the Visual Analogue Score (VAS) and disability using the Oswestry Disability Index (ODI) were measured. Psychological assessment used the Distress Risk Assessment Method (DRAM). Follow-up was at 1 year.Introduction
Methods
The recent NICE guidelines on management of osteoarthritis outline weight loss as first line treatment in degenerative joint disease in the obese. There is little data surrounding the effects of obesity on the outcomes in spinal surgical interventions. Intervertebral discectomy is one treatment for prolapse of a lumbar vertebral disc. We aim to investigate the effect of obesity on outcomes for discectomy. Demographic details including age, sex, weight and BMI were recording with a pre-operative Oswestry Disability Index (ODI). The fat thickness was measured at L5/S1 using calibrated MRI scans. Outcome measures included complications, length of surgery and change in ODI at 1 year following surgery. Obesity was defined as a body mass index of over 30. The units Serial patients undergoing discectomy were recruited into the study. Patients with bony decompression, instrumentation, revision surgery or multilevel disease were excluded. Fifty patients with a single level uncomplicated disc prolapse were entered into the study. Sixteen patients had a BMI over 30 and so were obese, whilst 34 had a BMI of less than 30. The mean pre-operative ODI was 46.5 in the obese group and 52 in the normal group this difference was not significant (p>
0.05). The mean post operative ODI was statistically improved in the high BMI group at 28 (18.5 point improvement) and 25.2 (29.1 point improvement) in the normal group. The ODI improvement was significantly better in the low BMI group (p=0.036). There was no significant difference in operative time (p=0.24). Only a single patient had a complication (dural leak), so no valid comparison could be made. The outcomes of spinal surgery in the obese are mixed. We found no increase in the complication rate or intra-operative time associated with an increased BMI. However, the improvement in ODI was significantly better in the normal BMI group.
All pre-operative parameters were significantly higher compared with the Normal group (back pain VAS 6.3 and 3.8; leg pain VAS 7 and 4.7; ODI 61 and 34.4 respectively). At 1 year follow-up, 23% of the somatising patients became psychologically Normal; 36% became At Risk; 11% became Distressed Depressed; and 30% remained Distressed Somatisers. The postoperative VAS for back and leg pain of the 11 patients who had become psychologically Normal was 3.4 (pre-op 6.8) and 3.2 (pre-op 6.6) respectively. In the 14 patients who remained Distressed Somatisers the corresponding figures were 5.6 (pre-op 7.8) and 6.7 (pre-op 7.0). The postoperative ODI of the 11 patients who had become psychologically Normal was 26.4 (pre-op 55.5). In the 14 patients who remained Distressed Somatisers the corresponding figures were 56.7 (pre-op 61.7). These differences are statistically significant.
All pre-operative parameters were significantly higher compared with the Normal group (back pain VAS 6.3 and 3.8; leg pain VAS 7 and 4.7; ODI 61 and 34.4 respectively). At 1 year follow-up, 23% of the somatising patients became psychologically Normal; 36% became At Risk; 11% became Distressed Depressed; and 30% remained Distressed Somatisers. The postoperative VAS for back and leg pain of the 11 patients who had become psychologically Normal was 3.4 (pre-op 6.8) and 3.2 (pre-op 6.6) respectively. In the 14 patients who remained Distressed Somatisers the corresponding figures were 5.6 (pre-op 7.8) and 6.7 (pre-op 7.0). The postoperative ODI of the 11 patients who had become psychologically Normal was 26.4 (pre-op 55.5). In the 14 patients who remained Distressed Somatisers the corresponding figures were 56.7 (pre-op 61.7). These differences are statistically significant.
Patients were 36 male and 84 females with the mean age at the time of revision surgery was 71.4 years (range 42 – 89 SD 9.7). In all the patients their indication for revision surgery was aseptic loosening. All the patients had impacted morsellised bone allograft as part of the reconstruction used with cemented prostheses. Clinical and radiological assessments of all patients were conducted for average of four years follow up.
Femoral Impaction allografting is now an established method in revision hip arthroplasty where there is a deficiency in bone stock. Most experience of this technique has been in conjunction with a cemented collarless, polished, tapered (CPT) stem. We conducted a retrospective study into the clinical and radiological results of 67 consecutive patients with an average of 62 months (36–108 months) follow-up. In all cases, Impaction bone grafting was performed using a transtrochanteric approach and cemented Charnley and Elite Plus stems. In our series no femoral component has been revised. The overall subsidence was 2.2 mm. 57 hips (85%) showed subsidence of 4 mm or less. However two patients showed massive subsidence of greater than 10mm, both with associated osteolysis and radiolucent lines. In addition, one stem showed a progressive varus position and debonding of the cement-metal interface. Analysis of the bone allograft showed evidence of incorporation in 56 (84%) of patients. The Merle D’Aubigne-Postal clinical score increased from an average of 8.3 pre-operatively to 15.3 at the last review. 60 patients (89.5%) complained of no or slight pain. There was a 10% re-operation rate due to complications. Three patients sustained periprosthetic fractures around the tip of the prosthesis, all successfully treated with a plate. Three patients suffered recurrent dislocation, two needed revision of the acetabula component. Two patients needed trochanteric wires removed for persistent pain. Direct comparison of different prostheses is difficult due to many confounding variables. However the medium term results of our study are comparable to the results reported using the Exeter and CPT stems.