High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique. SRS-22r and full-spine lateral radiographs were collected for the 28 young patients (age 13.4 years (SD 2.6) who underwent surgery for high-grade dysplastic spondylolisthesis in our centre (Scottish National Spinal Deformity Service) between 1995 and 2018. The mean follow-up was nine years (2 to 25), and one patient was lost to follow-up. The standard surgical technique was an all-posterior, partial reduction, and S1 to L5 transfixation screw technique without direct decompression. Parameters for segmental (slip percentage, Dubousset’s lumbosacral angle) and regional alignment (pelvic tilt, sacral slope, L5 incidence, lumbar lordosis, and thoracic kyphosis) and global balance (T1 spino-pelvic inclination) were measured. SRS-22r scores were compared between patients with a balanced and unbalanced pelvis at final follow-up.Aims
Methods
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
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:
