Aims. We aimed to evaluate the temperature around the nerve root during drilling of the lamina and to
determine whether irrigation during drilling can reduce the chance of
Background. Percutaneous endoscopic interlaminar discectomy (PEID) has achieved favorable effects in the treatment of lumbar disc herniation (LDH), as a new surgical procedure. With its wide range of applications, a series of complications related to the operation has gradually emerged. Objective. To describe the type, incidence and characteristics of the complications following PEID and to explore preventative and treatment measures. Study Design. Retrospective, observational study. Setting. A spine center affiliated with a large general hospital. Method. In total, 479 cases of patients with LDH received PEID, which was performed by an experienced spine surgeon between January 2010 and April 2013. Data concerning the complications were recorded. Result. All of the 479 cases successfully received the procedure. A total of 482 procedures were completed. The mean follow-up time was 44.3 months, ranging from 24 to 60 months. The average patient age was 47.8 years, ranging from 16 to 76 years. There were 29 (6.0%) related complications that emerged, including 3 cases (0.6%) of fragment omission, and the symptoms gradually eased following 3–6 weeks of conservative treatment; 2 cases (0.4%) of
Pedicle screw fixation is an effective and reliable method for achieving stabilization in lumbar degenerative disease. The procedure carries a risk of violating the spinal and neural canal which can lead to nerve injury. This audit examines the accuracy of screw placement using intra-operative image guidance. Retrospective audit of patients undergoing lumbar pedicle screw fixation using image guidance systems over an 18-month period. Case records were reviewed to identify complications related to screw placement and post-operative CT scans reviewed to study the accuracy of screw position. Of the 98 pedicle screws placed in 25 patients, pedicle violation occurred in 4 screw placements (4.1%). Medial or inferior breach of the pedicle cortex was seen in 2 screws (2%).
Current knowledge regarding upper limb myotomes is based on historic papers. Recent advances in magnetic resonance imaging (MRI) and surgical exploration with intraoperative nerve stimulation now allow accurate identification of
Purpose. Posterior lumbar fusion using minimally invasive surgical (MIS) techniques are reported to minimise postoperative pain, soft tissue damage and length of hospital stay when compared to the traditional open procedure. Methods. This is a review of patients who underwent MIS for posterolateral lumbar fusion in a single practice over a 2-year period. Results. Twenty-eight patients underwent this procedure. The median age was 57 (range 34-80). Male:female ratio was 1:1. The most common symptom was radicular pain (n=26). Two patients had back pain without radicular symptoms. Primary degenerative spondylolisthesis was seen in 22 patients and post-laminectomy spondylolisthesis in 3 patients. Transforaminal interbody fusion (TLIF) with pedicle screw fixation was the commonest procedure (20) while the rest had pedicle screw fixation and inter-transverse fusion. Along with fusion, nerve root decompression alone was performed in 19, while 5 had decompression of the central spinal canal. Intra-operative navigation was used to assist screw placement in 5 patients. The typical hospital stay was 3 days. All but two patients were mobilised the same or the following day. Twenty-one patients with radiculopathy (80%) reported improvement in VAS at 6-months. One patient suffered irreversible
Purpose: To describe the percutaneous transpedicular biopsy technique as a novel way of approaching lesion of the thoracic and lumbar spine, to determine the amount of bone retrievable through the pedicle and its diagnostic yield. Material and Methods: Seventy-nine patients underwent 84 biopsies. Seventy-seven procedures were performed with ßuoroscopic guidance arid seven with CT guidance. Seventy-one biopsies underwent under local anesthesia and ten under general anesthesia. Age range of patient was from 3 to 81 years. Results: Adequate specimens for correct diagnosis were obtained in 80 of the 84 patients with the following diagnoses. Pyogenic spondylodiscitis 31, tuberculosis 4, coccidiomycosis 2, echinococcus cyst 1, blastomycosis 1, brucella 4, primary neoplasm 7, metastatic neoplasms 16, osteoporotic fractures 8, osseous repair for insufþciency fractures 5, Pagetñs disease 1. The 4 negative biopsies subsequently proven to be Ç false negative È and were related to faulty biopsy techniques. Conclusion: Pitfalls can be avoided when adhering to the details of our technique. These pitfalls can occur while retrieving the instrumentation without simultaneous withdrawal of the guiding pin; crushing pathological soft tissue against sclerotic or normal bone; or when encountering a sclerotic lesion distal to normal bone without using a sequential type of biopsy specimen-retrieval technique. Any type of bleeding is controllable. The approach is a safe, efþcacious and cost effective and avoids so the problems such low diagnostic yield
Purpose: Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes. Methodology: Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management. Results: All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of
Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes. Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management. All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of
PURPOSE: Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes. METHODOLOGY: Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management. RESULTS: All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of
A prospective series of patients undergoing intradiscal electrothermal therapy for treatment of lower back pain refractory to physiotherapy. 33 patients with a mean follow up of 16 months were assessed pre- and postoperatively at Mayday University Hospital between 1999–2001 using visual analogue scores and SF-36. These patients failed to show an improvement with physiotherapy and had no evidence of a significant disc prolapse according to MRI with their back pain being reproduced at one or more disc levels on provocative discography. All procedures were performed as day cases with a temperature of 90 degrees being reached in all patients. Baseline and follow-up outcome measures indicated the SF-36 mean improvement of pcs to be 7.05 (P<
0.001) and the mean improvement of mcs 10.05 (P<
0.001) following IDET with a mean change of 1.5 in the visual analogue score. Overall 25 patients reported a noticeable improvement in their back pain symptoms with 3 patients recording worsening symptoms and the other 5 patients remaining unchanged. Surgical complications included 1 breakage of the catheter within the patient and a disc prolapse at the level of surgery that required subsequent discectomy. 30% of patients were noted to have a temporary foot drop postoperatively which was due to inadvertently performing a lumbar plexus block on infusion of local anaesthetic before catheter insertion. There was no reported discitis, deep infection or
Purpose of Study: To prospectively study the clinical and radiological outcomes following lumbar interbody fusion with an intersegmental device(SpineLink™, Biomet) in smokers versus non smokers. Materials and Methods: 64 patients who underwent spine fusion with intrasegmental fixation were prospectively studied at Mayday University Hospital. 54 patients with suffient follow up were included. Patients were assessed pre and postoperatively clinically using validated scoring systems (VAS pain score, SF-36 v1, Oswestry Disability Index). Radiologically classified into fused, indeterminate or pseudoarthrosis. Results: There were 54 patients in the analysis (34 patients in the smoker group and 20 patients in the non smoking group) with an average age of 52 years and an average follow-up of 28 months. 32 patients had multilevel procedures (25 two level, 5 three level, 2 four level). The treatment groups were comparable with respect to demographic, diagnostic (53% spondylolisthesis, 35% degenerative disc disease, 12% other) and surgical variables. No other significant medical problems affected patients in either group. Radiographically there were no pseudarthroses observed in either group. The SF-36 physical health score increased from 22.4 to 40.1 (+18.0) following surgery in smokers compared to an increase from 25.0 to 36.0 (+11.0) in non-smokers. The SF-36 mental health score increased from 36.4 to 45.0 (+8.6) in smokers compared to an increase of 30.8 to 42.7 (+2.9) in non-smokers. Complications included 2
Introduction: This is a report on results from the first three years of the British Spinal Registry. Background: The British Scoliosis Society supported a web based scoliosis registry in 2003. At the Britspine meeting in 2004 all four British spine societies (BSS, BASS, BCSS, SBPR) agreed to expand this to include all spinal surgical procedures in the United Kingdom. An extensive marketing and promotional campaign was targeted at all members of the four societies, and online and telephone support was provided. Aims: To report on the clinical results from the first three years registry activity. Methods: The British Spinal Registry is a web based out-come tool, collecting basic demographic and outcome data on spinal surgical procedures in the UK. Over three years from November 2004, 1410 patient data sets were entered. The activity analysis is party carried out using the online diagnostics that are part of the web based software tool, and partly with downloaded data. Results: 73 surgeons from 55 centres entered patient data on 1410 surgical episodes between November 2004 and December 2007. The number of patients entered per year has declined marginally, with 540 patients in the first year, 454 in the second and 416 in the third. The majority of cases entered have a low back diagnosis (842) of whom 106 were part of a BASS audit on discectomy. Of the low back cases 40% had disc herniation and 7.4% had previous surgery. The complications included dural tear (3.7%),
Study Design: A consecutive retrospective cohort including all patients treated by a single consultant spinal surgeon (BJCF) with targeted foraminal epidural steroid injection (FESI) for radicular pain. Objective: To assess the efficacy of targeted foraminal epidural steroid injection (FESI) for radicular pain in preventing surgical intervention. Summary of Background Data: 90% of sciatica resolves within 90 days. Beyond this period, decompresssive surgery for pain relief maybe considered. Open surgery however carries attendant risk including
Purpose of Study: It has been widely reported that smokers undergoing lumbar spinal surgery are more likely to develop postoperative complications such as pseudarthrosis, superficial and deep wound infection, as well as diminished clinical improvement. New spine instrumentation was developed (SpineLinkTM, Biomet) which enables surgeons to fuse multiple levels by linking single level fusions in series. This is accomplished through titanium links and polyaxialscrews which preserve lordosis without the bending of rods or plates. During an ongoing 5 year prospective investigation on fusion with intrasegmental fixation the authors analysed and compared outcomes in smokers versus non-smokers to determine the impact of this new system on outcomes in smokers. Materials and Methods: 64 patients who underwent spine fusion with intrasegmental fixation were prospectively studied at Mayday University Hospital beginning in 1997, 54 have sufficient follow-up to be included in the analysis. Patients were assessed pre and postoperatively, both radiographically and clinically, using validated outcome instruments including the SF-36. Results: There were 54 patients in the analysis (34 patients in the smoker group and 20 patients in the non-smoking group) with an average age of 52 years and an average follow-up of 28 months. 32 patients had multilevel procedures (25 two level, 5 three level, 2 four level). The treatment groups were comparable with respect to demographic, diagnostic (53% spondylolisthesis, 35% degenerative disc disease, 12% other) and surgical variables. No other significant medical problems affected patients in either group. Radiographically there were no pseudarthroses observed in either group. The SF-36 physical health score increased from 22.4 to 40.1 (+18.0) following surgery in smokers compared to an increase from 25.0 to 36.0 (+11.0) in non-smokers. The SF-36 mental health score increased from 36.4 to 45.0 (+8.6) in smokers compared to an increase of 30.8 to 42.7 (+2.9) in non-smokers. Complications included 2
Introduction: Treatment of thoracolumbar fractures remains controversial. The treatment options are conservative management or operative treatment, either through a posterior or anterior approach. Surgery through an anterior approach provides excellent decompression through vertebrectomy and the ability to correct the deformity. Stabilisation with Moss cage and Kaneda device remains unproven. Methods and Results: This is a retrospective study of 55 consecutive patients with thoracolumbar fractures operated on between 1993–99. Indications for surgery were: neurological deficit, two or three column injury causing instability or significant kyphotic deformity . There were 34 male and 21 female patients, mean age 33 years old. Trauma was caused by a fall from a height, either due to accident (30 patients) or suicide attempt (5), RTAs (14), sporting injury (6). Other injuries included multiple level spinal fractures (9 patients), pelvic (5), calcaneal (3), talar (1) and malleolar (1) fractures. Surgery was performed on the next available list unless there was an indication for emergency intervention, (mean 5 days post injury, range 1–19). Post-operative hospital stay averaged 17 days (7–59). Forty-seven patients underwent an anterior procedure alone, whilst eight patients had combined anterior and posterior instrumentation and fusion. Mean operative time was 207 minutes (150–360) and blood loss 2670 ml (985– 7000). Nineteen patients (35% of all) had neurological deficit. Neurological status improved post-op in 85% of these patients, remained the same in nine per cent and there was a
The most appropriate classification of traumatic thoracolumbar (TL) spine injuries remains controversial and current systems can be cumbersome and difficult to apply. No classification aids decision making in clinical management. Clinical spine trauma specialists from institutions around the world were canvassed with respect to information deemed pivotal in the communication of TL spine trauma and the clinical decision making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. The reliability and validity of an earlier version of this system has been demonstrated. The Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based upon the three most important injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurological status of the patient. These characteristics are largely independent of each other. A composite injury severity score can be calculated from these characteristics stratifying patients into surgical and non-surgical treatment groups. The three principal injury patterns are compression (including burst – 1 point each), translation/rotation (3 points) and distraction (4 points). Neurological status can be classified as a
Introduction: Spinal fusions have been shown to be useful in correcting spinal deformities resulting from degenerative disc disease. We sought to produce a prospective analysis of functional outcomes following lumbar spinal fusion surgery for degenerative spondylolisthesis or degenerative scoliosis secondary to degenerative disc disease. We present the interim results from our case cohort of 74 patients. Methods: Over a period of 3 years (2005–2007), all patients who presented to this private practice with symptoms of canal stenosis or radicular pain secondary to degenerative spondylolisthesis or degenerative scoliosis were offered decompressive laminectomy and posterior lumbar interbody fusion (PLIF) surgery with interbody cages, pedicle screw instrumentation, bone morphogenic protein (BMP) and bicalcium phosphate (BCP). Patients who presented only with low back pain and did not have radicular pain or neurogenic claudication were excluded from this study. All patients who were offered spinal fusion surgery were consecutively offered the opportunity to enrol in this functional cohort analysis. Those patients who consented were prospectively entered into this functional analysis and were asked to complete Oswestry and SF-36 function questionnaires preoperatively and post-operatively. Post-operative data has been collected in some cases up to 16 months postoperatively. Patients were also assessed post-operatively by the surgeon and given an Odom clinical assessment score. Complications were also collated. Results: 102 patients were offered surgery with 18 patients not consenting to participate in this study. Of the 84 patients who consented to participate in this study, 10 patients failed to submit both pre-operative and postoperative questionnaires, leaving 74 patients who were followed for a median 7 months (range of 1.5–16 months). There were 30 males and 44 females in the study with a median age of 73 (range 46–89). Of these 74 patients, 63 had degenerative spondylolisthesis and 11 had degenerative scoliosis. 52 patients had sufficient follow-up to assess bony fusion, of which 1 patient failed to fuse. 32 of the patients who fused reported to have improved, but 16 did not and the remainder did not submit both pre-operative and post-operative questionnaires. For the SF-36 questionnaire, the median pre-operative SF-36 score was 30 (96.6% CI 26–35) and the median post-operative SF-36 score was 48 (95.3% CI 42–56). The mean difference between the preoperative and post-operative SF-36 scores was 14 (95% CI 11–18) (p<
0.0001. The median preoperative Oswestry score was 46 (96.6% CI 42–50) and the median post-operative Oswestry score was 30 (96.6% CI 24–40) and the median post-operative Oswestry score was 30 (96.6% CI 24–40). The mean difference between the preoperative and post-operative Oswestry scores was 14 (95% CI 10–19) (p= 0.0001). 45 patients (61%) reported improvements of greater than 20 between their pre-operative and post-operative scores in either their SF-36 or Oswestry questionnaires. Of these 45 patients, 40 (89%) were also given moderate or good Odom (clinical) scores. 29 patients (39%) reported that they had not experienced improvement in their symptoms based on either their SF-36 or Oswestry questionnaires, with 12 (41%) of those 29 patients scoring poorly on their Odom scores. In all, there were 18 complications ranging from wound collections (4) and breakdowns (2) to repositioning of screws (6) and
The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up.Aims
Methods
Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in spinal surgery where there was no criticism of the surgical procedure itself. The fault that was identified was a failure to inform the patient of alternatives to, and material risks of, surgery, or overemphasizing the benefits of surgery. In one case, there was a promise that a specific surgeon was to perform the operation, which did not ensue. All of the faults in these cases were faults purely of the consenting process. In many cases, the surgeon claimed to have explained certain risks to the patient but was unable to provide proof of doing so. We propose a checklist that, if followed, would ensure that the surgeon would take their patients through the relevant matters but also, crucially, would act as strong evidence in any future court proceedings that the appropriate discussions had taken place. Although this article focuses on spinal surgery, the principles and messages are applicable to the whole of orthopaedic surgery. Cite this article:
The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016.Aims
Methods