Background context: Stable thoracolumbar spinal fracture is a common injury, yet there remains a relative lack of evidence that would allow reliable prediction of outcome. Variation in outcome in stable thoracolumbar spine fracture without neurological deficit could not be explained by the assessment made from x-rays and CT imaging alone, which measures mainly the bony injury severity. So far, no good classification system has been developed to assess the severity of soft tissue injury (disc). Objectives: To measure short-term outcome of stable
The purpose of this study was to evaluate and
compare the effect of short segment pedicle screw instrumentation and
an intermediate screw (SSPI+IS) on the radiological outcome of type
A
Stable
Study Design/Objectives: A pilot study to predict thoracolumbar kyphosis progression secondary to fracture in non-operatively treated patients. Summary of Background Data: Progressive saggital plane deformity can cause persistent pain after thoracolumbar vertebral fractures. Little data exists to suggest at what interval after the index injury the patient attains a low risk of developing further angular deformity in non-operatively treated patients. Methods: Supine and erect radiographs were assessed and the degree of fracture kyphosis was determined using an Oxford Cobbometer. The fracture kyphosis was recorded for each follow up appointment along with time after the fracture. A time/data analysis was performed using the Blyth-Still-Casella exact interval. Results: This study included 22 patients (13 male, 9 female) with average age 67.2 years (range, 14–87 years). The average length of follow up was 11.5 months (range, 5.3–19.9 months) and the average number of radiographs taken within this period was 4 (range, 2–6). The change in fracture kyphosis was plotted against time following fracture. Based on 15 patients with data extending to 200 days follow up, it was observed that the rate of change in fracture kyphosis between two time points of 100 and 150 days predicted the trend in kyphosis progression until the end of follow up in 14 out of the 15 patients. This observed rate of 14/15 (0.93) has a 95% confidence interval of 0.7 to 0.99 (Blyth-Still-Casella exact interval). Conclusions: The standing lateral radiograph of patients with conservatively treated
We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p <
0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p <
0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.
Of a total of 905 patients with fracture or fracture-dislocation of the thoracolumbar spine admitted from 1969 to 1982, a neurological deficit was present in 334 (37%). All unstable injuries were initially treated by reduction and posterior fusion. In 79 of these patients, an anterolateral decompression was undertaken later because of persistent neurological deficit and radiographic demonstration of encroachment on the spinal canal. One patient died of pulmonary embolism; 78 were reviewed after a mean period of four years. Of these 78 patients 18 made a complete neurological recovery while 53 appeared to have benefited from the procedure; 25 remained unchanged. The best results were obtained in burst
Introduction. The management of
The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
Many authors recommend surgery to remove retropulsed bone fragments from the canal in burst fractures to 'decompress' the spinal canal. We believe, however, that neurological damage occurs at the moment of injury when the anatomy is most distorted, and is not due to impingement in the resting positions observed afterwards. We studied 20 consecutive patients admitted to our spinal injuries unit over a two-year period with a T12 or L1 burst fracture. There was no correlation between bony or canal disruption and the degree of neurological compromise sustained but there was a significant correlation between the energy of the injury (as gauged by the Injury Severity Score) and the neurological status (p <
0.001). This suggests that neurological injury occurs at the time of trauma rather than being a result of pressure from fragments in the canal afterwards and questions the need to operate simply to remove these fragments.
In 139 patients with burst fractures of the thoracic, thoracolumbar or lumbar spine, the least sagittal diameter of the spinal canal at the level of injury was measured by computerised tomography. By multiple logistic regression we investigated the joint correlation of the level of the burst fracture and the percentage of spinal canal stenosis with the probability of an associated neurological deficit. There was a very significant correlation between neurological deficit and the percentage of spinal canal stenosis; the higher the level of injury the greater was the probability. The severity of neurological deficit could not be predicted.
Study design. Retrospective study. Objectives. To identify patient outcomes, in particular employment, >5-years following traumatic
Objectives. This presentation discusses the experience at our Centre with treating traumatic
Thoracolumbar injury classification systems are not used or researched extensively in paediatric population yet. This systematic review aims to explore the validity and reliability of the two main thoracolumbar injury classification systems in the paediatric population (age ≤ 18). It also aims to explore the transferability of adult classification systems to paediatrics. The Thoracolumbar Injury Classification System (TLICS) published in 2005 and the AO Spine published in 2013 were assessed in this paper because they both provide guidance for the assessment of the severity of an injury and recommend management strategies. A literature search was conducted on the following databases: Medline, EMBASE, Ovid during the period November 2020 to December 2020 for studies looking at the reliability and validity of the TLICS and AO Spine classification systems in paediatric population. Data on validity (to what extent TLICS/ AO Spine recommended treatment matched the actual treatment) and reliability (inter-rater and intra-rater reliability) was extracted. There is an “almost perfect validity” for TLICS. There is a “strong association” between the validity of TLICS and AO Spine. The intra-rater reliability is “moderate” for TLICS and “substantial” for AO Spine. The intra-rater reliability is “substantial” for TLICS and “almost perfect” for AO Spine. The six studies show a good overall validity and reliability for the application of TLICS and AO Spine in pediatric
Introduction:. Most of the published papers on AI based diagnosis have focused on the algorithm's diagnostic performance in a ‘binary’ setting (i.e. disease vs no disease). However, no study evaluated the actual value for the clinicians of an AI based approach in diagnostic. Detection of Traumatic
Study design: retrospective clinical study . Objective: To study radiological late results after posterior stabilization of
Background: Thoraco-lumbar fractures without a neurological deficit are usually suitable for non-operative treatment. The main area of clinical interest is the deformity at the injured levels. The deformity may be evident at the time of presentation, though could be expected to progress in time. Objective: Accurate assessment of the temporal behaviour in the geometry of the injured segments in non-operatively treated
Introduction: Spinal fractures are associated with pain, disability, neurological dysfunction and mortality. Osteoporosis and risky leisure time activities are increasing in the population. New treatment options have been introduced. However, only a few international studies have reported its descriptive epidemiology. There are no clear consensuses regarding the choice of operative interventions versus non-operative treatment in patients with
Background: There is conflicting evidence of correlation between clinical outcome and severity of thoracolumbar spine fractures in neurologically intact patients. 1. Kalyan et al2 presented the results of their prospective study of thoracolumbar spinal fractures and concluded that the clinical outcome was consistently better predicted by the severity of disc injury than that of the bony fracture. They suggested that if severe disc injury was present, treatment of the disc injury may result in a better short term clinical outcome. The aim of this study was to detail the incidence and type of disc injury in patients with thoracolumbar spinal fractures with intact neurology. Methods: Retrospective analysis of a prospectively collected spinal injury database at a regional spinal injuries unit. Only patients with a thoracolumbar spinal fracture and intact neurology were included. Retrospective analysis of magnetic resonance imaging (MRI) findings. One hundred and thirty nine neurologically intact patients (89M:50F, mean age 36 years, range 15 – 77yrs) with a thoracolumbar (T11 –L5) spinal fracture were admitted to our spinal unit over the last 11 years (1994 – 2004). Patient data was collected prospectively onto a spinal injuries database. All of these patients had an MRI scan on admission. All types of
Purpose: The purpose of this study was to analyse the results and morbidity of video-assisted minimally invasive thoracoctomy for anterior arthrodesis of
Introduction: Treatment of
Purpose of study: There is a controversy in the surgical treatment of unstable
Introduction and Objective. Up to 30% of
Introduction. In all traumatic injury there is a clear relationship between the structural tissue damage and resultant disability after recovery. There are no publications that compare significant thoracolumbar osseous injury to non specific soft tissue injury. Aim. To compare spinal outcome measures between patients with self reported back pain in the workplace perceived as injury to those having sustained structural injury in the form of an unstable
Introduction: Introduction of the minimal invasive surgery as a new concept in spinal surgery necessitated the need for implants that can be applied through minimal invasive approaches. One of the great challenges was the development of anterior minimal invasive vertebral replacement implants that are mechanically fit and easily applicable. Many studies were concerned with the early results of such implants but not yet the long-term or late ones. Methods: Between January 2003 and December 2003 we have operated 23 patients (13 males and 10 females) with traumatic thoracic or
Purpose of the study: The treatment of
The June 2023 Spine Roundup360 looks at: Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma; Sublingual sufentanil for postoperative pain management after lumbar spinal fusion surgery; Minimally invasive bipolar technique for adult neuromuscular scoliosis; Predictive factors for degenerative lumbar spinal stenosis; Lumbosacral transitional vertebrae and lumbar fusion surgery at level L4/5; Does recall of preoperative scores contaminate trial outcomes? A randomized controlled trial; Vancomycin in fibrin glue for prevention of SSI; Perioperative nutritional supplementation decreases wound healing complications following elective lumbar spine surgery: a randomized controlled trial.
Decision-making regarding operative versus non-operative treatment of patients with
The progressive kyphosis and pain in patients with acute
Background: It has been reported that there is poor correlation between neurological injury and degree of bony retropulsion in
Introduction: The management of patients with
Exact knowledge of the site of the lesion, and a better understanding of the traumatic mechanisms have led to a major improvement in the surgical approach used for the treatment of
To analyse the pain distribution in the acute and chronic phase following
Background.
This study was designed to assess the inter-observer reliability and intra-observer reproducibility of standard radiographic evaluation of 150
The evaluation of early results of combined percutaneous pedicle screw fixation and kyphoplasty for the management of thoraco-lumbar burst fractures. Between October 2008 and April 2009, 9 patients with
Guidelines for cervical trauma x-rays highlight the necessity for visualization of the C7-T1 junction. However, despite 15% of
We hypothesised whether MIS techniques confer any benefit when treating
We have studied the intervertebral discs adjacent to fractured vertebral bodies using MRI in 63 patients at a minimum of 18 months after injury. There were 75
Aim: To compare the radiological and functional outcomes of compression type thoracolumbar vertebral fractures treated with cloth-type thoracolumbar orthosis fitted with steel plates and bed rest. Methods: This prospective comparative study was done between July 2004 and January 2007. Twenty three patients (17 male, 6 female) with compression type (Magerl A1) thoracolumbar vertebral fractures were included. No patient had associated neurogical findings or additional injury. Eleven patients were treated with cloth-type thoracolumbar orthosis and 12 patients with only bed rest. Bed rest group cases were instructed to stand up and walk around as possible as they tolerated after pain relief just only in the house under the supervision of it’s relates. All cases were evaluated at last follow-up with SF-36 questionaire, clinical and radiological examination. Results: There was no significant difference between two groups with regard to demographic data. Radiological parameters including anterior compression angle, local kyphosis angle, sagittal index and anterior vertebral height were measured and compared on initial admittion, on the third month and at the last visit showing no significant difference (p>
0.05). Clinical evaluation was performed via work and pain criteria described by Denis. We found no significant difference between both groups for functional criteria (p>
0.05). Mental and physical points of SF-36 questionaire were recorded and compared dispaying no difference (pmental=0.15, pphysical=0.44). Conclusion: Magerl type A1
Purpose of the study: Kyphoplasty was introduced to reinforce the anterior column in osteoporotic vertebral fractures. It can be used for non-osteoporotic fractures. The purpose of this work was to report the clinical and radiographic results of kyphoplasty for non-ostoporotic vertebral fractures. Material and methods: From December 2005 to August 2008, we followed prospectively 21 patients (12 M, 9 F) mean age 45 years (16–58) treated for
Introduction: The use of an ejection seat to escape from a stricken aircraft is associated with the exposure of significant forces. These vertical accelerative forces on the body are in the order of 15–25G with rates of onset of up to 250G per second. Therefore, it is common to see vertical compression fractures, mainly in the thoracolumbar region. Although most vertebral fractures are evident on plain radiographs, subtle spinal injuries elsewhere may not be immediately apparent. Aim: A prospective study to evaluate for the presence of occult spinal injuries using MRI following aircraft ejection. Methods: Between 1996 and 2003, 22 ejectees from 18 aircrafts, mean age 32 years (range 24 to 48), were admitted to a regional spinal unit for comprehensive evaluation of their injuries that included whole spine radiographs and Magnetic Resonance Imaging (T1, T2 weighted and STIR sagittal sequences). All ejections occurred within the ejection envelope and were flying below 2000 ft (mean 460 feet) and below 500 knots airspeed (mean 275 knots). Results: All 5 ejectees (23%) with vertebral compression fractures, one at T6 and 4 in thoracolumbar region, had pain and tenderness in the appropriate area of the spine that was evidently detected on plain radiographs. 3 of these patients with a
Purpose: Minimally invasive video-assisted thoracotomy can be proposed for potentially unstable fractures of the thoracolumbar junction with rupture of the anterior column after satisfactory posterior reduction and osteo-synthesis. Long-term results are improved in terms of graft quality and stability of the postoperative angular gain. Material and methods: Ninety-one patients, mean age 36 years, with spinal fractures involving T12 to L2 underwent video-assisted mini-thoracotomy for arthrodesis as a complementary procedure after posterior reduction and osteosynthesis without bone graft. The left approach was preferred over the right due to the lower risk of bleeding. A massive tricortical anterolateral iliac graft was inserted in the intersomatic space. Perfect stability was achieved with the MIASPAS system which provides an exact measure of the intersomatic space and the bone graft. Results: Follow-up was five years for the first patients and ten months for those operated on after January 2003. At last follow-up, functional outcome (Stauffer-Coventry score) was excellent or good in 52% and 41% of the patients respectively. Outcome was poor in 7%. Postoperative radiograms demonstrated 100% graft fusion which was confirmed by tomography. There was no loss of angular gain. Discussion: This novel approach provides a means of preserving the posterior instrumentation and achieving anterior fusion in the zone of maximal stress. Because of the relative facility of the technique together with the operative time and the relatively low risk of postoperative complications, surgical indications for complementary intersomatic arthrodesis can be revisited. Anterior fusion is, in our opinion, the only sure means of maintaining long-term correction. The ability to access the disc, generally without metameric hemostasis, eliminates the risk of vascular cord lesions. Conclusion: This thoracoscopic technique for anterior fusion after a short posterior osteosyntheis without graft will greatly modify indications for complementary anterior fusion for the treatment of unstable
The Mater Hospital is Ireland’s primary referral centre for spinal injuries receiving 80–90% of all spinal cases annually. In today’s society the number of people competing at more competitive and professional levels is also increasing. Over the years, a lot of work has gone into safety precautions in sport. However despite those improvements our impression was that the incidence of both minor and serious sporting injuries is increasing. The purpose of this study was to determine the incidence, pattern and mechanism of sports-related spinal injuries in Ireland over the last decade. Data was collected by performing an audit of the National Spinal Injuries Database from 1994–2001. This database is a prospective computerized database. Data entered relates to the initial presentation, mechanism, level of injury and their acute in-hospital management. On average 200–220 patients are admitted annually to the National Injuries Spinal Unit. 173 of these were related to sport, which represented 13% of total spinal injuries. 80% are male under 40 years. 29% sustained neurological deficit. The sports responsible for most spinal injuries in Ireland were equestrian (43.8%), followed by rugby (16.4%), diving (15%), GAA (13.6%) and skiing (3%). Rugby injuries were most likely to cause neurological damage. Equestrian accidents commonly caused
The October 2012 Spine Roundup. 360. looks at: a Japanese questionnaire at work in Iran; curve progression in degenerative lumbar scoliosis; the cause of foot drop; the issue of avoiding the spinal cord at scoliosis surgery; ballistic injuries to the cervical spine; minimally invasive oblique lumbar interbody fusion; readmission rates after spinal surgery; clinical complications and the severely injured cervical spine; and stabilising the
Aims: To study the efþcacy of Texas Scottish Rite Hospital transpedicular screws versus laminar hooks in lumbar spine. Methods: 40 patients with unstable
Introduction: The optimal treatment for acute
Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for
INTRODUCTION: The optimal treatment for acute
Introduction: The poor correlation between neurological injury and degree of retropulsion in
Temporary immobilisation of joints can lead to permanent ankylosis or fusion. The aim of this study is to demonstrate that treatment of vertebral fractures by single level fusion and 2 level fixation preserves movement in the unfused lower motion segment after removal of metalwork. 12 consecutive
Introduction: Video assisted thoracoscopic surgery (VATS) is associated with good correction ability for spinal deformity and allow the reconstruction of the anterior column of the spine in tumors, deformity and trauma cases. Stand alone and instrumented procedures are possible. VATS has shown to be safe and can reduce the morbidities of traditional open anterior surgery but is a technically demanding procedure with a steep learning curve. The potential technique-related complication rate is low in experienced hands. Material and Methods: From 2006 till today, 22 thoracic vertebral fractures have been treated with thoracoscopic approach. The mean patients age was 32 years (24–58) and the levels treated between T6 and L1. Five fractures required only anterior approach, with corpectomy, implantation of an expandable cage (Obelisk, Ulrich, Germany) with autologous bone graft and an anterior Macs TL plate (Aesculap, Germany). The others seventeen fractures were treated by combined anterior – posterior approach in the same operating session or, the second, previously performed immediately after the admission. The endoscopic splitting of the diaphragm was performed in 9 cases to expose the L1/L2 levels. Seven patients received decompressive laminectomy during the first posterior approach performed in emergency settings. Endoscopic anterior decompression was required in 5 cases. One thoracic drainage was inserted and removed on third day in most cases. Results: The thoracoscopic approach allowed a reduction of blood loss, better pulmonary function, an earlier mobilization of the patients and a shorter hospital stay. With the experience the duration of surgical time decreased of one third. The mean duration of the procedure was 190 minutes and the blood loss of 220 ml. There were no major complications. In the first group of 8 cases a delayed removal of the thoracic drain and three conversion in open thoracotomy occurred. The patients were radiologically evaluated for bony fusion, sagittal alignement and by VAS and Oswestry scale for the overall satisfaction about the treatment. The mean follow-up time was 10 months (4–32). We didn’t found any loss of correction more than 5 degree. Conclusion: VATS permits a better visualization of the anatomic structures and allows the same reconstruction capabilities of the open technique with a faster recovery, a shorter hospitalization and a better cosmetic results. We observed a significant reduction in postoperative pain and drugs delivered for it. The clinical results have been encouraging. We believe that this technique can be a valuable tool in the management of the
Introduction: Surgical treatment of thoracolumbar spine fractures from T11 to L2 with correction of the traumatic kyphosis should be expected to avoid the deceptions observed with former treatments. Material and methods: Seventy trauma victims (41 men and 29 women) underwent surgery between 1996 and 2003. According to the Denis classification, they presented: 16 compressions, 43 burst fractures, 8 seat belt fractures, and 3 disclocations. The Frankel classification was E:62, A:2, C2, D:2. Mean follow-up was 30.7 months. A pedicle screw protected with sublaminal hooks below and pediculotransverse claws above was used in 50 patients with a hybrid configuration in 20. Reduction was achieved by in situ cerclage. A secondary anterior graft was implanted for 38 patients. Results: Patients were allowed to rise without contention on day 3. The traumatic angle measured with the sagittal index of Farcy (SIF) (the quality parameter used to study reduction) was 17 preoperatively and 1.6 after surgery. The loss at last follow-up was −2.2° with 81% of patients presenting normal or over correction. The loss was greatest (5.2°) for uniquely posterior approaches. The final Oswestry score was 29.8 (range 6–80) with a better result for the double approaches (20.7 versus 37.4, p<
0.001). Complications were phlebitis (n=1), sutured dural breaches (n=2), disassembly and nonunion (revision with a double approach) (n=1), infection (treated by wash-out and antibiotics) (n=10), retroperitoneal hematoma (treated by embolization) (n=1). Thirty-two patients resumed their work at seven months on average and 13 did not (25 without professional occupation). Discussion: The overall results are better than those after orthopedic treatment. The rate of resumed work was 71%. This is an excellent result with a less aggressive treatment protocol (no corset) and shorter hospital stay (5–19 days). The protective hooks facilitate in situ cerclage, avoiding catching the screws and the risk of disassembly. The anterior graft is necessary when the reduction is discal and reduces the angle loss leading to less morbidity. Conclusion: In situ cerclage enables constant sustained reduction of
The lumbar spine consists of a mobile segment of 5 vertebrae, which are located between the relatively immobile segments of the thoracic and sacral segments. The bodies are wider and have shorter and heavier pedicles, and the transverse processes project somewhat more laterally and ventrally than other spinal segments. The laminae are shorter vertically than are the bodies and are bridged by strong ligaments. The spinous processes are broader and stronger than are those in the thoracic and cervical spine. Internal fixation as an adjunct to spinal fusion has become increasingly popular in recent years. Stainless steel or titanium plates or rods are longitudinally anchored to the spine by hooks or pedicle screws. Powerful forces can be applied to the spine through these implants to correct deformity. Implants provide immediate rigid spinal immobilization, which allows for early patient mobilization, and provides a more optimal environment for bone graft incorporation. Numerous clinical and experimental studies demonstrate higher fusion rates in patients with rigid internal fixation than in controls without instrumentation. Although various implants are available, pedicle fixation systems are the most commonly used implant type in the lumbosacral spine. The large size of the lumbar pedicles minimizes the number of instrumented motion segments required to achieve adequate stabilization. Many authors have reported loss of postoperative deformity correction after transpedicular screw fixation, ranging from 2.5 degrees to 7.1 degrees. The general preference is to stabilize the fractured vertebra by fusing one level above and one level below. With this technique, the rate of loss of correction is high. At our institution, we routinely stabilize the unstable
Introduction: The management of thoraco-lumbar burst fractures remains controversial. Different authors have advocated immobilisation, external bracing or internal fixation by either anterior or posterior approaches. Advocates of posterior fixation have in general performed stabilisation one level above and one level below the site of the fracture, resulting in fixation of two motion segments. It is known that multi-segmental spinal fusion produces undesirable biomechanics. To stabilise the site of the fracture and avoid unnecessary fixation of an uninjured segment the senior author (T.S.) for selected patients has been using a novel technique of monosegmental fixation with placement of pedicle screws directly into the fractured vertebral body. Methods: All patients with thoraco-lumbar burst fractures admitted to St Vincents and Concord Hospitals between January 2001 and October 2003 were considered for monosegmental fixation. Patients with severe osteoporosis or complete loss of vertebral body height (“vertebra plana”) were excluded. All patients underwent surgical decompression and fixation within 10 days of injury. Fixation was obtained with 4 titanium pedicle screws and a single transverse connector (Xia System Stryker Spine). Reduction of kyphotic deformity was carried out in selected patients. Average blood loss for the procedure was 250 ml with no patients requiring transfusion. All patients had a minimum of 6 months radiological and clinical follow-up. Results: Since January 2001, 18 patients with
With advances in surgical technique and instrumentation, the anterior approach to the thoracolumbar spine becomes more popular. Anterior approach is considered particularly when ventral decompression of neural structures is needed, providing optional stability by fusing the involved segment with instruments specially designated for that purpose. The usual approach is done through a 10th or 11th rib thoracotomy, opening of the pleural cavity and a semilunar cut at the periphery of the diaphragm, in order to expose the anterolateral aspect of the vertebral column. This technique involves the risk of phrenic nerve injury and diaphragmatic paralysis combined with morbidity of the chest tube. A variant of that technique is the retrodiaphragmatic approach, which provides the surgeon with the advantages of ventral exposure, potentially avoiding the morbidity of the standard transpleural thoracotomy. Methods: During a three-year period, all patients with major anterior pathology at the T11, T12 or Ll level, were operated using the retrodiaphragmatic anterior approach. This involved an 10th or 11th rib thoracotomy with the patient in a lateral decubitus position. Following rib resection, blunt dissection of the diaphragm from the chest wall was performed without its surgical incision. The parietal pleural was mobilized medially and left intact and the thoracolumbar spine was exposed for the procedure. In case of a major pleural defect, a chest drain was inserted. Results: Fifteen patients (10 males and 5 females, mean age: 32.6y) made up by study group. This included six patients who had a
The direct posterior approach with subperiosteal dissection of the paraspinal muscles from the vertebrae is considered to be the standard approach for the surgical treatment of adolescent idiopathic scoliosis (AIS). We investigated whether or not a minimally-invasive surgery (MIS) technique could offer improved results. Consecutive AIS patients treated with an MIS technique at two tertiary centres from June 2013 to March 2016 were retrospectively included. Preoperative patient deformity characteristics, perioperative parameters, power of deformity correction, and complications were studied. A total of 93 patients were included. The outcome of the first 25 patients and the latter 68 were compared as part of our safety analysis to examine the effect of the learning curve.Aims
Methods
We present a series of 14 patients presenting to the senior surgeon’s practice who sustained
Anterior only procedure for stable thoraco-lumbar burst fractures is controversial. Prospective collection of clinical and radiological data in stable burst fractures with neurological deficit undergoing anterior only decompression and stabilisation with 2-year follow-up. 14 consecutive patients (8 females, 6 males) with two-column
Aims: The purpose of this study was to evaluate the clinical and radiological results of expandable titanium cages for vertebral body replacement in a prospective clinical trial. Methods: Since 04/1999 81 patients with
Introduction: The threshold for internal fixation of
Surgical decompression of the spinal canal is presently accepted worldwide as the method of treatment for
Introduction and Aims: Speculation exists with regard to the exact mechanism of remodelling of
Objective. To evaluate the outcomes of the treatment of acute
Loosening of pedicle screws is a major complication of posterior
spinal stabilisation, especially in the osteoporotic spine. Our
aim was to evaluate the effect of cement augmentation compared with
extended dorsal instrumentation on the stability of posterior spinal
fixation. A total of 12 osteoporotic human cadaveric spines (T11-L3) were
randomised by bone mineral density into two groups and instrumented
with pedicle screws: group I (SHORT) separated T12 or L2 and group
II (EXTENDED) specimen consisting of T11/12 to L2/3. Screws were
augmented with cement unilaterally in each vertebra. Fatigue testing
was performed using a cranial-caudal sinusoidal, cyclic (1.0 Hz)
load with stepwise increasing peak force.Aims
Materials and Methods
Introduction and Aims: Autologous bone is the preferred method of providing structural support in spinal surgery. The disadvantages are donor site morbidity and limited bone available to reconstitute the anterior column. We evaluated fresh frozen femoral allografts following anterior column reconstruction for lumbar burst fractures with neurological deficit. Method: Twenty-seven patients with neurological deficit ( Frankel grade A(3), B(7), C(16) D (1) due to burst fractures of the dorsolumbar junction were treated with fresh frozen allografts following anterior spinal decompression. The average age was 28 years, and 19 patients sustained the injury following a road traffic accident. The mean pre-operative kyphosis measured 190. A corpectomy was performed in all patients and femoral allografts were positioned by interference fit and the spine stabilised with an anterior rod screw construct. The radiographs were reviewed at three-monthly intervals and the fusion graded by an independent radiologist. Results: The follow-up in 24 patients ranged from 29 to 72 months (mean 43 months) and three patients were excluded due to inadequate follow-up. Allograft incorporation was assessed by criteria of Bridwell et al grade 1 fused with remodelling with cross trabeculae into the adjacent vertebral bodies, grade 11 graft intact, not fully remodelled and incorporated, no lucenies, grade 111 graft intact, but a definite lucency at the top or bottom of the graft, grade 1V not fused with resorption and collapse of graft. The allografts were stable and evidence of graft incorporation and remodelling were observed between eight and 24 months. Grade 1 fusion was seen in 23 patients at two years and subsequent follow-up revealed no fracture, resorption or collapse. The average neurological recovery, which was 1.4 Frankel grades (range 0–2 grades), occurred within seven weeks following surgery (range 11–74 days). Nine patients (37%) made a complete recovery and in four patients (16%) there was no improvement. The mean post-operative kyphosis at two years was 80 (range 2–180). At seven-year follow-up one patient had an asymptomatic grade 11 fusion following secondary infection due to TB which was successfully treated. Conclusion: The indications for the operative treatment of
Patients with multiple myeloma (MM) develop deposits in the spine
which may lead to vertebral compression fractures (VCFs). Our aim
was to establish which spinopelvic parameters are associated with
the greatest disability in patients with spinal myeloma and VCFs. We performed a retrospective cross-sectional review of 148 consecutive
patients (87 male, 61 female) with spinal myeloma and analysed correlations
between spinopelvic parameters and patient-reported outcome scores.
The mean age of the patients was 65.5 years (37 to 91) and the mean
number of vertebrae involved was 3.7 (1 to 15).Aims
Patients and Methods
The authors present the results of a cohort study of 60 adult
patients presenting sequentially over a period of 15 years from
1997 to 2012 to our hospital for treatment of thoracic and/or lumbar
vertebral burst fractures, but without neurological deficit. All patients were treated by early mobilisation within the limits
of pain, early bracing for patient confidence and all progress in
mobilisation was recorded on video. Initial hospital stay was one
week. Subsequent reviews were made on an outpatient basis. Aims
Method
The aim of this study was to report a retrospective, consecutive
series of patients with adolescent idiopathic scoliosis (AIS) who
were treated with posterior minimally invasive surgery (MIS) with
a mean follow-up of two years ( We prospectively collected the data of 70 consecutive patients
with AIS treated with MIS using three incisions and a muscle-splitting
approach by a single surgeon between June 2013 and February 2016
and these were retrospectively reviewed. There were eight male and
62 female patients with a mean age of 15 years (Aims
Patients and Methods
The April 2015 Spine Roundup360 looks at: Hyperostotic spine in injury; App based back pain control; Interspinous process devices should be avoided in claudication; Robot assisted pedicle screws: fad or advance?; Vancomycin antibiotic power in spinal surgery; What to do with that burst fracture?; Increasing complexity of spinal fractures in major trauma pathways; Vitamin D and spinal fractures
The August 2014 Spine Roundup360 looks at: rhBMP complicates cervical spine surgery; posterior longitudinal ligament revisited; thoracolumbar posterior instrumentation without fusion in burst fractures; risk modelling for VTE events in spinal surgery; the consequences of dural tears in microdiscectomy; trends in revision spinal surgery; radiofrequency denervation likely effective in facet joint pain and hooks optimally biomechanically transition posterior instrumentation.
The June 2013 Spine Roundup360 looks at: the benefit of MRI in the follow-up of lumbar disc prolapse; gunshot injury to the spinal cord; the link between depression and back pain; floating dural sack sign; short segment fixation at ten years; whether early return to play is safer than previously thought; infection in diabetic spinal patients; and dynesis.
The purpose of this study was to determine whether
patients with a burst fracture of the thoracolumbar spine treated
by short segment pedicle screw fixation fared better clinically
and radiologically if the affected segment was fused at the same
time. A total of 50 patients were enrolled in a prospective study
and assigned to one of two groups. After the exclusion of three
patients, there were 23 patients in the fusion group and 24 in the
non-fusion group. Follow-up was at a mean of 23.9 months (18 to
30). Functional outcome was evaluated using the Greenough Low Back
Outcome Score. Neurological function was graded using the American
Spinal Injury Association Impairment Scale. Peri-operative blood transfusion requirements and duration of
surgery were significantly higher in the fusion group (p = 0.029
and p <
0.001, respectively). There were no clinical or radiological
differences in outcome between the groups (all outcomes p >
0.05).
The results of this study suggest that adjunctive fusion is unnecessary
when managing patients with a burst fracture of the thoracolumbar
spine with short segment pedicle screw fixation.
There are three basic concepts that are important to the biomechanics of pedicle screw-based instrumentation. First, the outer diameter of the screw determines pullout strength, while the inner diameter determines fatigue strength. Secondly, when inserting a pedicle screw, the dorsal cortex of the spine should not be violated and the screws on each side should converge and be of good length. Thirdly, fixation can be augmented in cases of severe osteoporosis or revision. A trajectory parallel or caudal to the superior endplate can minimise breakage of the screw from repeated axial loading. Straight insertion of the pedicle screw in the mid-sagittal plane provides the strongest stability. Rotational stability can be improved by adding transverse connectors. The indications for their use include anterior column instability, and the correction of rotational deformity.
It has been proposed that intervertebral disc degeneration might be caused by low-grade infection. The purpose of the present study was to assess the incidence of herpes viruses in intervertebral disc specimens from patients with lumbar disc herniation. A polymerase chain reaction based assay was applied to screen for the DNA of eight different herpes viruses in 16 patients and two controls. DNA of at least one herpes virus was detected in 13 specimens (81.25%). Herpes Simplex Virus type-1 (HSV-1) was the most frequently detected virus (56.25%), followed by Cytomegalovirus (CMV) (37.5%). In two patients, co-infection by both HSV-1 and CMV was detected. All samples, including the control specimens, were negative for Herpes Simplex Virus type-2, Varicella Zoster Virus, Epstein Barr Virus, Human Herpes Viruses 6, 7 and 8. The absence of an acute infection was confirmed both at the serological and mRNA level. To our knowledge this is the first unequivocal evidence of the presence of herpes virus DNA in intervertebral disc specimens of patients with lumbar disc herniation suggesting the potential role of herpes viruses as a contributing factor to the pathogenesis of degenerative disc disease.
Impacted bone allograft is often used in revision joint replacement. Hydroxyapatite granules have been suggested as a substitute or to enhance morcellised bone allograft. We hypothesised that adding osteogenic protein-1 to a composite of bone allograft and non-resorbable hydroxyapatite granules (ProOsteon) would improve the incorporation of bone and implant fixation. We also compared the response to using ProOsteon alone against bone allograft used in isolation. We implanted two non-weight-bearing hydroxyapatite-coated implants into each proximal humerus of six dogs, with each implant surrounded by a concentric 3 mm gap. These gaps were randomly allocated to four different procedures in each dog: 1) bone allograft used on its own; 2) ProOsteon used on its own; 3) allograft and ProOsteon used together; or 4) allograft and ProOsteon with the addition of osteogenic protein-1. After three weeks osteogenic protein-1 increased bone formation and the energy absorption of implants grafted with allograft and ProOsteon. A composite of allograft, ProOsteon and osteogenic protein-1 was comparable, but not superior to, allograft used on its own. ProOsteon alone cannot be recommended as a substitute for allograft around non-cemented implants, but should be used to extend the volume of the graft, preferably with the addition of a growth factor.