The aim of this study was to prospectively assess the outcome of patients with metastatic spinal disease who underwent minimally invasive fixation of the spine for intractable pain or spinal instability. This is a prospective audit of patients with metastatic spinal cord disease who have undergone minimally invasive fixation of the spine from August 2009 until the present date. This was assessed by pre and post-operative Oswestry Disability Index (ODI), EQ5D and Tokuhashi scores. Intra- and post-operative complications, time to theatre, length of inpatient stay, analgesia requirements, mobility, chest drain requirement and post-operative HDU and ITU stays were also recorded. So far, 10 patients have met the criteria. There were no intra-operative complications. Post-operatively, there were no complications, chest drains, increase in analgesia or stay on the HDU or ITU. All patients showed an improvement in mobility. The mean post-operative day of mobilisation was 2 days, post-operative days until discharge 5.3 days and length of inpatient stay was shorter than traditional surgery. Blood loss was minimum except one patient with metastatic renal cell carcinoma who needed transfusion intraoperatively. ODI, VAS and EQ-5D scores were calculated and were significantly improved compared to preoperatively. This novel approach to management of metastatic spinal disease has resulted in improved mobility, short inpatient stays without the need for chest drains, HDU or ITU and an improved the quality of life in pallliative patients. This is a completely new strategy to treat the pain in these patients without the usual associated risks of surgery and has major advantages over traditional surgical techniques which may preclude this group of patients having any surgical stabilisation procedure at all
Many operations have been recommended to treat Pars Interarticularis fractures that have separated and are persistently symptomatic, but little other than conservative treatment has been recommended for symptomatic incomplete fractures. 10 consecutive patients aged 15–28 [mean 21.7 years] were treated operatively between 2010–2014. All but one were either professional athletes [3 cricketers, 2 athletics, 1 soccer] or academy cricketers [3 patients]. 8 patients had unilateral fractures, and two had bilateral fractures at the same level. The duration of pre-operative pain and disability with exercise ranged from 4–24 months [mean 15.4 months]. The operation consists of a percutaneous compression screw inserted through a 1.5cm midline skin incision under fluoroscopic guidance: 6 cases were also checked with the O-arm intra-operatively. Post-operation the patients were mobilised with a simple corset and discharged the following day with a customised rehabilitation program. All 12 fractures in 10 patients healed as demonstrated on post-operative CT scans at between 3–6 months. One patient had the screw revised at 24 hours for an asymptomatic breach, and one patient developed a halo around the fracture site without screw loosening, and had a successful revision operation to remove the screw and graft the pars from the screw channel. All patients achieved a full return to asymptomatic activity, within a timescale of 4–12 months post-surgery, depending on the sport. Athletes that have persistent symptoms from incomplete pars interarticularis fractures should consider
Objectives. This presentation discusses the experience at our Centre with treating traumatic thoracolumbar fractures using percutaneous pedicle screw fixation and also looks at clinical and radiological outcomes as well as complications. Design. This is a retrospective study reviewing all cases performed between Jan 2013 and June 2019. Subjects. In our study there were 257 patients in total, of which there were 123 males and 134 females aged between 17 and 70. Methods. We reviewed the case notes and imaging retrospectively to obtain the relevant data. Results. A total of 257 patients were included, 123 males and 134 females; the mean age was 47.6 years. The majority of injuries were from fall from significant height. In 98 cases the fracture involved a thoracic vertebra and in 159 cases a lumbar vertebra. Percutaneous pedicle screw fixation was performed either one level above and below fracture or Two levels above and below the fracture depending upon the level of injury. Forty two cases were treated with additional short pedicle screws at the level of fracture. More than 15% (39) of patients presented with a neurological deficit on admission and more than 80% (32) of those showed post-operative improvement in their neurology as per Frankel Grading system. The mean Operative time was 117minutes +− 45, and mean length of hospital stay was 7.2 +− 3.8 days, with significant improvement in Visual analogue score.
Background. Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery. Objective. To compare the safety and therapeutic efficacy of
We reviewed the outcome of a retrospective case series of eight patients with atlantoaxial instability who had been treated by percutaneous anterior transarticular screw fixation and grafting under image-intensifier guidance between December 2005 and June 2008. The mean follow-up was 19 months (8 to 27). All eight patients had a solid C1–2 fusion. There were no breakages or displacement of screws. All the patients with pre-operative neck pain had immediate relief from their symptoms or considerable improvement. There were no major complications. Our preliminary clinical results suggest that percutaneous anterior transarticulation screw fixation is technically feasible, safe, useful and minimally invasive when using the appropriate instruments allied to intra-operative image intensification, and by selecting the correct puncture point, angle and depth of insertion.
We reviewed 15 consecutive patients, 11 women and four men, with a mean age of 48.7 years (37.3 to 62.6), who between July 2004 and August 2007 had undergone percutaneous sacroiliac fusion using hollow modular anchorage screws filled with demineralised bone matrix. Each patient was carefully assessed to exclude other conditions and underwent pre-operative CT and MR scans. The diagnosis of symptomatic sacroiliac disease was confirmed by an injection of local anaesthetic and steroid under image intensifier control. The short form-36 questionnaire and Majeed’s scoring system were used for pre- and post-operative functional evaluation. Post-operative radiological evaluation was performed using plain radiographs. Intra-operative blood loss was minimal and there were no post-operative clinical or radiological complications. The mean follow-up was for 17 months (9 to 39). The mean short form-36 scores improved from 37 (23 to 51) to 80 (67 to 92) for physical function and from 53 (34 to 73) to 86 (70 to 98) for general health (p = 0.037). The mean Majeed’s score improved from 37 (18 to 54) pre-operatively to 79 (63 to 96) post-operatively (p = 0.014). There were 13 good to excellent results. The remaining two patients improved in short form-36 from a mean of 29 (26 to 35) to 48 (44 to 52). Their persistent pain was probably due to concurrent lumbar pathology. We conclude that percutaneous hollow modular anchorage screws are a satisfactory method of achieving sacroiliac fusion.
