Objectives. To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. Methods. A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods
We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion.Objectives
Methods
Cement augmentation of pedicle screws could be used to improve screw stability, especially in osteoporotic vertebrae. However, little is known concerning the influence of different screw types and amount of cement applied. Therefore, the aim of this biomechanical A total of 54 osteoporotic human cadaver thoracic and lumbar vertebrae were instrumented with pedicle screws (uncemented, solid cemented or fenestrated cemented) and augmented with high-viscosity PMMA cement (0 mL, 1 mL or 3 mL). The insertion torque and bone mineral density were determined. Radiographs and CT scans were undertaken to evaluate cement distribution and cement leakage. Pull-out testing was performed with a material testing machine to measure failure load and stiffness. The paired Objectives
Materials and Methods
Pedicle-lengthening osteotomy is a novel surgery for lumbar spinal stenosis (LSS), which achieves substantial enlargement of the spinal canal by expansion of the bilateral pedicle osteotomy sites. Few studies have evaluated the impact of this new surgery on spinal canal volume (SCV) and neural foramen dimension (NFD) in three different types of LSS patients. CT scans were performed on 36 LSS patients (12 central canal stenosis (CCS), 12 lateral recess stenosis (LRS), and 12 foraminal stenosis (FS)) at L4-L5, and on 12 normal (control) subjects. Mimics 14.01 workstation was used to reconstruct 3D models of the L4-L5 vertebrae and discs. SCV and NFD were measured after 1 mm, 2 mm, 3 mm, 4 mm, or 5 mm pedicle-lengthening osteotomies at L4 and/or L5. One-way analysis of variance was used to examine between-group differences.Objectives
Methods
There is no universally agreed definition of
cauda equina syndrome (CES). Clinical signs of CES including direct
rectal examination (DRE) do not reliably correlate with cauda equina (CE)
compression on MRI. Clinical assessment only becomes reliable if
there are symptoms/signs of late, often irreversible, CES. The only
reliable way of including or excluding CES is to perform MRI on
all patients with suspected CES. If the diagnosis is being considered,
MRI should ideally be performed locally in the District General
Hospitals within one hour of the question being raised irrespective
of the hour or the day. Patients with symptoms and signs of CES
and MRI confirmed CE compression should be referred to the local
spinal service for emergency surgery. CES can be subdivided by the degree of neurological deficit (bilateral
radiculopathy, incomplete CES or CES with retention of urine) and
also by time to surgical treatment (12, 24, 48 or 72 hour). There
is increasing understanding that damage to the cauda equina nerve roots
occurs in a continuous and progressive fashion which implies that
there are no safe time or deficit thresholds. Neurological deterioration
can occur rapidly and is often associated with longterm poor outcomes.
It is not possible to predict which patients with a large central
disc prolapse compressing the CE nerve roots are going to deteriorate neurologically
nor how rapidly. Consensus guidelines from the Society of British Neurological
Surgeons and British Association of Spinal Surgeons recommend decompressive
surgery as soon as practically possible which for many patients
will be urgent/emergency surgery at any hour of the day or night. Cite this article:
