Use of ultrasonic bone scalpel (UBS) is becoming popular in spinal surgery. This study presents the safety profile of UBS for posterior release in surgical correction of adolescent idiopathic scoliosis (AIS). From 2016 to 2018, UBS (Misonix) was used by the senior author in a variety of spinal operations. Data for intraoperative complications when this devise was used for posterior correction of AIS were collected. Revision cases were excluded. UBS was used for posterior release of AIS in 65 patients (58 female, seven male) with an average age of 15.6 years (range 11–23). Average length of posterior instrumentation was 12 levels (range 6–14). Instrumentation was exclusively from T2 to L4. To achieve adequate release for correction, UBS was used to perform a total of 644 modified in-situ chevron osteotomies (average ten, range six to 12) and 31 rib osteotomies. Overall, three complications (4.6 %) were directly related to the use of UBS: one haemopneumothorax, which was successfully treated with a chest drain; and two loss of motor-evoked potentials during monitoring, which led to the postponement of the final correction. These two patients did not have any neurological problems and their surgery was completed successfully within 1 week of the initial surgery. One late deep infection was reported. This was not thought to be directly related to the use of UBS. Use of UBS in the posterior surgical treatment of AIS appears to be relatively safe with a low level of acceptable complications. However, appropriate training is required for the use of UBS.
Less invasive single-rod fusion technique may be indicated in the management of NMS to minimise operative time, blood loss and wound-related complications. This retrospective 12-year cohort study (2008–2020) aims to evaluate and compare the outcomes of this technique to the current standard dual rod technique to determine their safety and efficacy. 28 patients in the single rod group (Mean age = 16.4 [SD ±4.0]) and 30 in the double rod group (Mean age = 16.3 [SD±3.5]). Indications included a minimum 2 year follow period, detailed information on the type of implant and a complete pre- and post-operative imaging and medical records. Baseline demographics, comorbidities, and surgical characteristics were collected. Outcomes assessed included the immediate post-op and final follow up angles and general complications. All outcome analysis was performed using a regression approach. Angles at final follow-up: lumbar (Difference ratio (DR)= 2.60 [95% CI 0.37 – 18.4], p=0.25), thoracic (DR= 1.08 [95% CI 0.19 – 6.28], p=0.92), thoracolumbar (major curve angle) (DR 1.35 [95% CI 0.60 – 3.06], p=0.46) and kyphosis (DR = 0.97 [0.66, 1.42] p=0.86). There was no statistically significant difference, between the two groups, for any of the above angle outcomes as well as for length of surgery, blood loss and complication outcomes. Both single and double rod instrumentation achieves satisfactory and safe deformity correction which is maintained at final follow up. A larger scale study is warranted to further assess these techniques while also conducting a cost-benefit analysis between them.
Patients with metastatic spinal cord compression (MSCC) or unstable spinal lesions warrant early surgical consultation. In multiple myeloma, chemotherapy and radiotherapy have the potential to decompress the spinal canal effectively in the presence of epidural lesions. Mechanical stability conferred by bracing may potentiate intraosseous and extraosseous bone formation, thus increasing spinal stability. This study aims to review the role of non-operative management in myeloma patients with a high degree of spinal instability, in a specialist tertiary centre. Retrospective analysis of a prospectively collected database of 83 patients with unstable myelomatous lesions of the spine, defined by a Spinal Instability Neoplastic Score (SINS) of 13–18. Data collected include patient demographics, systemic treatment, neurological status, radiological presence of cord compression, most unstable vertebral level and presence of intraosseous and extraosseous bone formation. Post-treatment scores were calculated based on follow-up imaging which was carried out at 2 weeks for cord compression and 12 weeks for spinal instability. A paired t-test was used to identify any significant difference between pre- and post-treatment SINS and linear regression was used to assess the association between variables and the change in SINS.Introduction
Methods
SPECT-CT is a hybrid imaging modality, which has become very well established in the diagnosis of inflammatory, vascular and malignant processes affecting the spine. However, little evidence exists on its application with degenerative pathologies. Systematic review on the use of SPECT-CT in the diagnosis of degenerative facet joint arthropathy.Background Context
Purpose & Study Design
Fracture of the odontoid process (OP) in the elderly is associated with mortality rates similar to those of hip fracture. The aim of this study was to identify variables that predict mortality in patients with a fracture of the OP, and to assess whether established hip fracture scoring systems such as the Nottingham Hip Fracture Score (NHFS) or Sernbo Score might also be used as predictors of mortality in these patients. We conducted a retrospective review of patients aged 65 and over with an acute fracture of the OP from two hospitals. Data collected included demographics, medical history, residence, mobility status, admission blood tests, abbreviated mental test score, presence of other injuries, and head injury. All patients were treated in a semi-rigid cervical orthosis. Univariate and multivariate analysis were undertaken to identify predictors of mortality at 30 days and one year. A total of 82 patients were identified. There were 32 men and 50 women with a mean age of 83.7 years (67 to 100).Aims
Patients and Methods
