Study design: Long-term retrospective study of the low grade isthmic Spondylolisthesis treated by means of instrumented posterolateral fixation in adults.

Objective: To evaluate clinical and functional survival of surgical treatment of the espondylolisthesis after minimum 10 years of follow-up. To study the radiologic behaviour of the fused and the adjacent level.

Summary of background: It’s been suggested in many different series that posterolateral instrumented fusion is not always capable to improve the lumbar pain neither to stabilize a vertebral segment if the anterior column is not supported. The need to perform and interbody fusion in the surgical treatment of isthmic spondilolysthesis is still unknown.

Material and method: From a total of 42 patients operated by low grade isthmic espondylolisthesis, it’s been obtained a clinic and radiological follow up in 31 patients, 19 females and 12 males. The average age at the moment of surgery was 34.9 years and in the last review was 46.5 years. The average follow up has been 11.8 years. Pain and functional disability was quantified by a visual analogical Scale (VAS) and the Oswestry Disability Index (ODI). Quality of life was assessed by the SF-36. The preoperative and postoperative percentage of slip and lumbosacral kyphosis was evaluated in serial radiographs at the fused level. The intervertebral disc height and dynamic behaviour was evaluated at the adjacent level.

Results: Spondylolisthesis was present at L5 in 24 patients, L4 in 6 patients and at L3 in 1 patient. In the 87% of cases the fusion was one level and the 3% was two levels. The mean (range) anterior slip at postoperative was 21.9%, and 23.1% at the final follow up. The average angle for the lumbosacral kyphosis was 19.4° in the postoperative and 19.5° in the follow up. The Oswestry Disability Index scores average at follow up was 13,6. 75.8% of patients were considered with a minimum disability and 17.2% with a moderate disability. The 67.7% of the patients develop rewarded activities, the 25.6% develop domestic tasks and the 6.45% are in a disability situation. There was no statistically significant difference between the study population SF-36 scores and those of the general population, same age and gender, in any of the eight domains.

Conclusions: Long-term clinical and radiographic outcomes after “in situ” posterolateral instrumented fusion of adult low-grade Spondylolisthesis were satisfactory. This study further confirms that such surgery is appropriate for these selected patients.

Objective: The purpose of this study was to evaluate the effectiveness of surgical reconstruction of posttraumatic deformity. Posttraumatic kyphosis (PTK) causes pain, neurological deficit, sagittal imbalance, progressive deformity, cosmetic and functional deterioration. Its treatment is cause of controversy and technically demanding. There are few reviews in the literature about the results of its surgical treatment.

Methods: From 1995 to 2002 twenty-one patients suffering from posttraumatic thoracolumbar kyphosis were operated. The average follow-up was 3.9 years (range 6 – 1 years). The average age was 38 years (range 23–62): 13 female and 8 male. All patients complained about vertebral pain, 16 located at the apex of the deformity, 2 patients in the lumbar area and 3 patients referred also pain above the lesion. Three patients had irradiated circumferential pain and 4 patients mild neurological deficit. Two patients showed sexual dysfunction. In one patient only anterior approach with allograft reconstruction and anterior plate fixation was performed. In 17 patients simultaneous or staged approach with posterior release, anterior discectomy and allograft reconstruction and posterior compressed instrumentation was performed. In three patients a posterior closing wedge osteotomy was performed

Results: Postoperative pain decreased from 7.5 to 2.8 (VAS). Functional status: preoperative 42.3 % and postoperative 13.8% (Oswestry score). There was no hardware failure. All cases showed solid fusion without significant loss of correction. The average corrected kyphosis was 27.3°. All patients were satisfied with their cosmetic result. No cavity drainage was performed in 2 patients with syringomielia. 1 of 4 patients with neurological deficit did not improve. Two patients had thoracic neuropathic postoperative pain; one of them needed pain clinic treatment until remission. One case had superficial infection. One patient showed a Chylous leakage.

Discussion: Only few works analyze the results of surgical treatment of PTK. The controvesrsy between anterior-aposterior surgery versus posterior closing wedge osteotomy depens of classification of posttraumatic spinal deformities based on three criteria: the region involved, the neurological status and the presence of any sagittal or frontal plane deformities outsides the local kyphosis

Conclusions: Our results suggest that the double approach with anterior allograft and posterior instrumentation shows clinical and radiological efficacy for sagittal posttraumatic deformity. In spite of surgical risk, there have been few complications with a high rate of patient satisfaction.

Study design: retrospective clinical study .

Objective: To study radiological late results after posterior stabilization of thoracolumbar fractures with internal fixation. To know factors related with loss of correction and hardware failure.

Summary of background data: The posterior approach using an internal fixator is a standard procedure for stabilizing the injured thoracolumbar spine. None of the surgical techniques used was able to maintain the corrected the kyphosis angle.

Methods: Forty-five patients with thoracolumbar fractures were included in the study. The inclusion criterion was the presence of fracture through the T11-L3 vertebrae without neurologic compromise. The Load-sharing classification has been used for all patients to determine the fracture severity. Surgical techniques (short or long instrumentation) , preoperative and postoperative radiographs ( Cobb technique) and follow-up records of all patients were reviewed carefully from the time of surgery until final follow-up assessment.

Results: 13 patients were treated using short-segment instrumentation (two disc spaces) and 32 patients with long-segment instrumentation (more than two disc spaces). The mean follow-up was 3.4 years (range 1 to 11 years). The mean preoperative Cobb angle was 16.1 degrees and after surgery the mean angle was 6.8° representing an average correction of 9.2 ° . At follow-up assessments the mean Cobb angle was 13.2° representing a loss of correction of 6.4°. Implant failure ( 5 loosening and 8 breakage) was seen in 28.8% of patients: 6/14 (42%) of patients receiving short instrumentation and 7/31 (22%) of patients with long instrumentation. Hardware failure was seen in 53.3% of patients with Cobb angle preoperative more than 20° and in 16.6% of patients with Cobb angle less than 20°.

Conclusions: Radiological behaviour of thoracolumbar fractures treated with posterior instrumentation without anterior support was worse than expected. Hardware failure was related with Cobb angle fracture > 20°, postoperative correction superior than 10° and short pedicular instrumentation technique.

Aim: To evaluate the role of selective arterial embolization of Aneurysmal Bone Cyst of the mobile spine (C1-L5). Ten to 35% of aneurysmal bone cyst arises from the mobile spine. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. No previous series analyses this aspect. Methods: Fourteen cases of Aneurysmal Bone Cyst of the mobile spine were retrospectively reviewed. All charts, radiographs, and images were reviewed allowed for oncologic and surgical staging of these cases. The mean follow-up was 3,5 years (2,5y Ð 11y) and the mean age at diagnosis was 22 years. Lumbar and cervical spine was more frequently involved (5 cases cervical and 5 lumbar). Histologic diagnosis was obtained in all cases. A slow and gradual onset of pain was the constant symptom. In all cases an arterial study was performed and in thirteen cases a selective arterial embolization (SAE) was performed. Six of them were repeated Results:Only two patients shows complete ossiþcation of the cyst without surgery (T10 and T1) and was curative. All the others patients received surgical treatment (curettage or en bloc excision) In three of them a recurrence of disease was diagnosed 6, 8 and 12 months later. Two of the most recent cases shows a little lityc area without symptoms Conclusions: Selective arterial embolization seems NOT be sufþcient to obtain ossiþcation of Aneurysmal Bone Cyst o mobile spine

Introduction and Objectives: This is a retrospective study on the treatment of lumbar degenerative disk disease (LDDD) using intervertebral arthroplasty. The lack of uniformity in the treatment of LDDD, persistence of pain even with solid fusion, and the possibility of changes over the fusion site have encouraged us to seek other solutions for this condition. Total intervertebral arthroplasty has been proposed as a possible alternative for selected cases of LDDD.

Materials and Methods: Between November 1999 and July 2002, 16 patients with LDDD were treated surgically using third-generation total intervertebral arthroplasty (Link SB Charité III) with a chromium-cobalt alloy and ultra-high molecular weight (UHMW) poly-ethylene. Average follow-up time was 14 months (6-36 months), and average age was 42 years (35–52). There were 11 females and 5 males. All patients underwent radi-olographic studies, CT scan, MRI, and discography (minimum 2 levels). Indications included LDDD of one to three segments, absence of root tension signs, absence of complete disc collapse, and iconography including concordant discography. LDDD was primary in 11 cases and post-discectomy in 5 cases. Surgery was indicated when at least 6 months of conservative treatment failed to yield results. Blood loss and length of hospital stay were compared to a similar group that underwent posterolateral arthrodesis. Pain, function, and degree of disability were evaluated before and after surgery using GEER (1999) instruments for the evaluation of degenerative lumbar pathology. Increase in height of the posterior intervertebral space and segmentary lordosis were also measured.

Results: Preoperative VAS: 7.8; postoperative VAS: 2.3. Disability index (Oswestry) was 41.3% preoperative and 10.8% postoperative. Average increase in height of posterior intervertebral space was 2.4mm, and mean segmental lordosis was 19.5°, which remained constant through the end of the follow-up period. Average hospital stay was 4.8 days (3–15) compared with 7.5 (5–18) for a group of patients who underwent suspended arthrodesis of L4–L5 with a much smaller quantity of blood loss. No infections were found. Complications: One patient developed an epidural haematoma, which was treated conservatively. Another developed a postoperative retroperitoneal haematoma, which was also treated conservatively. In neither case was there an adverse effect on the outcome of the procedure. One patient showed malpositioning of the prosthetic components on follow-up radiographs, with poor clinical progression at one year postoperative. The patient was treated with posterolateral fusion and right L5 foraminotomy. No infections were seen.

Discussion and Conclusions: Treatment of LDDD with intervertrebral arthroplasty was shown to be effective in the short term, if strict guidelines are followed. Aggressive surgical management is highly inferior to conventional arthrodesis. A longer follow-up period is needed to confirm the validity of this treatment. Technical error in malpositioning of the components in one case caused a poor result.