We performed a retrospective follow-up study investigating the safety and efficacy of an independently constructed non-linked double rod system for anterior column reconstruction. Our objective was to demonstrate safe and cost effective adaptation of a standard deformity system for use in anterior column reconstruction. Anterior only surgery in patients requiring corporectomy spares the posterior soft tissue envelope. Corporectomy and neural decompression is followed by insertion of a titanium mesh cage and bone graft. Several non-adaptable implant systems (locking plates and linked-rod constructs) have been validated both in clinical and in-vitro studies and are available to the surgeon. These devices can only be used to address the anterior column and can only span a limited number of spinal segments. Twenty-two patients have undergone anterior column reconstruction for tumour (8), trauma (11) and infection (3) in our unit are included. Mean follow up was 30.5 months. All had anterior corporectomy and decompression, insertion of a titanium mesh cage and stabilisation with an anterior non-linked dual rod construct (Synthes USS II). Follow-up records and radiographs have been analysed. Ninety-five percent of patients fused clinically and radiologically on plain radiograph examination. There was no failure of metalwork or deterioration in neurological function following surgery. There were 5 deaths in the study group, 4 from progression of metastatic malignant tumour and one within 30 days of surgery. Three patients have had local malignant disease recurrence, two requiring posterior decompression and one requiring further anterior surgery. This system is effective and safe. It allows fewer implants to be carried by individual hospitals and thus reduces hospital costs.
The study was designed to quantify the hit/miss ratio of non-radiologically assisted caudal epidurals, assessing both accuracy of entry into the epidural space and adequacy flow of contrast and therapeutic agents to the level of pre-defined pathology. We studied 146 consecutive patients listed for a caudal epidural under sedation for either radicular pain or spinal stenosis. When the surgeon was happy with placement of the needle its position was assessed using image intensifier and injection of radio-opaque dye (Omnipaque). The epidurogram was also used to confirm the level of pathology had been reached by the steroid and local anaesthetic. Three patients were excluded because of inadequate records. Five patients did not attend for their procedure. Of the remaining 138 patients Consultant spinal surgeons carried out 75 procedures and the remaining 63 cases were performed by “middle grade” surgeons. 36 of 138 patients (26%) had placement of spinal needle outside the epidural space after first blind placement. Hit rate was not related to surgeon grade, patient age or patient diagnosis. In 6% of cases the radio-opaque dye did not reach the level of documented pathology had been reached by the dye. 2 patients had a “spinal” pattern of block requiring overnight admission, there were no other complications recorded. A miss rate of 26% in the blind placement of spinal needles through the sacral hiatus in caudal epidurals is unacceptable. We would therefore recommend position of the needle is confirmed radiologically and epidurogram is used to confirm accurate delivery of the therapeutic agents.
