Object

Giant thoracic discs (occupying more than 40% of the spinal canal) are a difficult surgical pathology. They are increasingly being recognized as or particular subset of thoracic disc pathology. It has been recommended that an aggressive surgical approach of open 2 level verteberectomy and instruments should be utilized.21 However Retropleural thoracotomy provides the shortest direct route to the anterior thoracic spine and avoids pleural cavity entry making it an ideal if infrequently used approach to access ventral thoracic and thoracolumbar spine abnormalities. We present a detailed description of our experience utilising this approach, for the treatment of Giant Thoracic discs without the need for vertebrectomy or instrumentation

The “Wallis” implant is indicated to stabilize symptomatic degenerative lumbar spine segments, relieving low back pain related to instability and thus delaying the need for irreversible, more invasive surgical management. The purpose of this study was to provide the first objective clinical evaluation of the “Wallis” lumbar dynamic stabilisation system.

An independent prospective observational study was carried out utlising SF-36, Oswestry Disability Index (ODI) and visual analogue pain scores (VAS). Surgical pathologies in which this technique was used, the intra-operative and post-operative complications and length of post-op stay were recorded. 102 patients underwent Wallis insertion between June 2007- May 2009, Median age 51.5 (range 28-108). 94% of patients completed questionnaires and were followed up at 3, 6 and 12 month time points. ODI scores decreased from pre-op 39 to 27 at twelve months (p<.0016). VAS back pain scores decreased 59 to 36 (p<0.0001). Leg scores decreased 50 to 39 (p<0.0002). SF 36 scores improved significantly, physical functioning 46 to 59, physical health 30 to 54 and social functioning 47 to 68. 50% of patients believed their health to be better 12 months post-op. Pre-operatively 28% of patients were employed and working with 26% off work due to back problems. This rate increased steadily with 42% employed at 12 months. Two implants were removed, one due to non-benefit with subsequent arthrodesis and one due to infection. One superficial wound infection occurred.

The Wallis dynamic stabilization system provides a superficial and easily reversible surgical procedure with a lower complication rate than conventional athrodesis. Used in patients with painful degenerative lumbar conditions their quality of life objectively approached values of the age- and gender-matched general population.

Several surgical options have been utilised to treat patients with back dominant lumbar disc disease. The purpose of our study was to compare the outcomes in patients who underwent lumbar fusion with an expandable interbody device (B-TWIN) using different surgical techniques (PLIF, TLIF or posterolateral screws alone)

Observational study, retrospective analysis of prospectively collected data. Patients underwent a single level lumbar fusion. Group A: PLIF with B-Twin cage; Group B: TLIF with B-Twin cage and unilateral pedicle screw fixation and Group C: bilateral posterolateral screw fixation alone.

Functional outcomes were assessed using: SF-36, Oswestry Disability Index (ODI), Distress and Risk Assessment Method scores (DRAM) and the visual analogue pain scores (VAS).

There were 32 patients, 24 female and 8 male. Average age was 45 (range 33-63). Average follow up was12 months (range 2-36). Level of spinal fusion was 2 L3/4, 11 L4/5 and 13 L5/S1. Mean hospital stay was 5.8 days.

VAS improved in all 3 groups A 5.83 – 5; B 8 – 4.83; C 5.71 – 2.3.

ODI improved in all 3 groups A 0.5 – 0.35; B 0.51 – 0.44, C 0.42 – 0.16.

There was no statistical difference on comparison of the three groups.

There were no operative complications. One patient broke her interdody device during a all in the first post-operative week requiring a subsequent procedure.

Lumbar interbody fusions can safely be performed using an expandable interbody device. Good functional outcomes can be achieved in the majority of well selected patients