The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016.Aims
Methods
The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression.Aims
Patients and Methods
Aims. As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative complications in patients undergoing simple or complex lumbar spinal fusion. Methods. We retrospectively reviewed 584 patients who had undergone lumbar spinal fusion for degenerative lumbar spinal disease. The 'simple' group (SG) consisted of patients who had undergone one- or two-level posterior lumbar fusion. The 'complex' group (CG) consisted of patients who had undergone fusion over three or more levels, or combined anterior and posterior surgery. On admission, the mFI-5 was calculated and nutritional parameters collected. Results.
The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes. We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group.Aims
Methods
Aims. Magnetically controlled growing rod (MCGR) systems use non-invasive
spinal lengthening for the surgical treatment of early-onset scoliosis
(EOS). The primary aim of this study was to evaluate the performance
of these devices in the prevention of progression of the deformity.
A secondary aim was to record the rate of complications. Patients and Methods. An observational study of 31 consecutive children with EOS, of
whom 15 were male, who were treated between December 2011 and October
2017 was undertaken. Their mean age was 7.7 years (2 to 14). The
mean follow-up was 47 months (24 to 69). Distractions were completed
using the tailgating technique. The primary outcome measure was
correction of the radiographic deformity. Secondary outcomes were
growth, functional outcomes and complication rates. Results. The mean Cobb angle was 54° (14° to 91°) preoperatively and 37°
(11° to 69°) at the latest follow-up (p < 0.001). The mean thoracic
kyphosis (TK) was 45° (10° to 89°) preoperatively and 42° (9° to
84°) at the latest follow-up. The mean T1–S1 height increased from
287 mm (209 to 378) to 338 mm (240 to 427) (p < 0.001) and the
mean sagittal balance reduced from 68 mm (-76 to 1470) preoperatively
to 18 mm (-32 to 166) at the latest follow-up. The mean coronal balance
was 3 mm (-336 to 64) preoperatively and 8 mm (-144 to 64) at the
latest follow-up. The mean increase in weight and sitting and standing
height at the latest follow-up was 45%, 10% and 15%, respectively.
The mean Activity Scale for Kids (ASKp) scores increased in all
domains, with only personal care and standing skills being significant
at the latest follow-up (p = 0.02, p = 0.03). The improvements in
Cobb angle, TK and T1-S1 heights were not related to gender, the
aetiology of the EOS, or whether the procedure was primary or conversion
from a conventional growing rod system. A total of 21 children developed
23 complications at a rate of 0.23 per patient per year. Seven developed
MCGR-specific complications.
Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them.Aims
Methods
To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management. We reviewed 88 consecutive patients with a severe Scheuermann's kyphosis who had undergone posterior spinal fusion with closing wedge osteotomies and hybrid instrumentation. There were 55 males and 33 females with a mean age of 15.9 years (12.0 to 24.7) at the time of surgery. We recorded their demographics, spinopelvic parameters, surgical correction, and perioperative data, and assessed the impact of surgical complications on outcome using the Scoliosis Research Society (SRS)-22 questionnaire.Aims
Methods
To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire.Aims
Methods
The aim of this study was to identify the risk factors for adverse events following the surgical correction of cervical spinal deformities in adults. We identified adult patients who underwent corrective cervical spinal surgery between 1 January 2007 and 31 December 2015 from the MarketScan database. The baseline comorbidities and characteristics of the operation were recorded. Adverse events were defined as the development of a complication, an unanticipated deleterious postoperative event, or further surgery. Patients aged < 18 years and those with a previous history of tumour or trauma were excluded from the study.Aims
Methods
We analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions. There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p <
0.001). Screws of 5 mm diameter should not be used for sacral fixation. Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technically-demanding method.
The aim of this study was to evaluate improvements in the quality
and safety of paediatric spinal surgery following the implementation
of a specialist Paediatric Spinal Surgical Team (PSST) in the operating
theatre. A retrospective consecutive case study of paediatric spinal operations
before (between January 2008 and December 2009), and after (between
January 2012 and December 2013) the implementation of PSST, was
performed. A comparative analysis of outcome variables including
surgical site infection (SSI), operating time (ORT), blood loss (BL),
length of stay (LOS), unplanned staged procedures (USP) and transfusion
rates (allogenic and cell-saver) was performed between the two groups.
The rate of complications during the first two postoperative years
was also compared between the groups.Aims
Patients and Methods
We present the results of correcting a double or triple curve
adolescent idiopathic scoliosis using a convex segmental pedicle
screw technique. We reviewed 191 patients with a mean age at surgery of 15 years
(11 to 23.3). Pedicle screws were placed at the convexity of each
curve. Concave screws were inserted at one or two cephalad levels
and two caudal levels. The mean operating time was 183 minutes (132
to 276) and the mean blood loss 0.22% of the total blood volume
(0.08% to 0.4%). Multimodal monitoring remained stable throughout
the operation. The mean hospital stay was 6.8 days (5 to 15).Aims
Patients and Methods
Patients seeking cervical spine surgery are thought to be increasing
in age, comorbidities and functional debilitation. The changing
demographics of this population may significantly impact the outcomes
of their care, specifically with regards to complications. In this
study, our goals were to determine the rates of functionally dependent
patients undergoing elective cervical spine procedures and to assess
the effect of functional dependence on 30-day morbidity and mortality
using a large, validated national cohort. A retrospective analysis of the American College of Surgeons
National Surgical Quality Improvement Program data files from 2006
to 2013 was conducted to identify patients undergoing common cervical
spine procedures. Multivariate logistic regression models were generated
to analyse the independent association of functional dependence
with 30-day outcomes of interest.Aims
Patients and Methods
We compared the clinical, radiological and quality-of-life
outcomes between hybrid and total pedicle screw instrumentation
in patients undergoing surgery for neuromuscular scoliosis. Total pedicle screw instrumentation provided shorter operating
times, less blood loss and better correction of the major curve
compared with hybrid constructs in patients undergoing surgery for
neuromuscular scoliosis.
The outcome of surgery for recurrent lumbar disc
herniation is debatable. Some studies show results that are comparable
with those of primary discectomy, whereas others report worse outcomes.
The purpose of this study was to compare the outcome of revision
lumbar discectomy with that of primary discectomy in the same cohort
of patients who had both the primary and the recurrent herniation
at the same level and side. A retrospective analysis of prospectively gathered data was undertaken
in 30 patients who had undergone both primary and revision surgery
for late recurrent lumbar disc herniation. The outcome measures
used were visual analogue scales for lower limb (VAL) and back (VAB)
pain and the Oswestry Disability Index (ODI). There was a significant improvement in the mean VAL and ODI scores
(both p <
0.001) after primary discectomy. Revision surgery also
resulted in improvements in the mean VAL (p <
0.001), VAB (p
= 0.030) and ODI scores (p <
0.001). The changes were similar
in the two groups (all p >
0.05). Revision discectomy can give results that are as good as those
seen after primary surgery. Cite this article:
An eight-week-old boy developed severe thoracic
spondylodiscitis following pneumonia and septicaemia. A delay in
diagnosis resulted in complete destruction of the T4 and T5 vertebral
bodies and adjacent discs, with a paraspinal abscess extending into
the mediastinum and epidural space. Antibiotic treatment controlled
the infection and the abscess was aspirated. At the age of six months,
he underwent posterior spinal fusion Spondylodiscitis should be included in the differential diagnosis
of infants who present with severe illness and atypical symptoms.
Delayed diagnosis can result in major spinal complications with
a potentially fatal outcome.
Increasing numbers of posterior lumbar fusions
are being performed. The purpose of this study was to identify trends
in demographics, mortality and major complications in patients undergoing
primary posterior lumbar fusion. We accessed data collected for
the Nationwide Inpatient Sample for each year between 1998 and 2008
and analysed trends in the number of lumbar fusions, mean patient
age, comorbidity burden, length of hospital stay, discharge status,
major peri-operative complications and mortality. An estimated 1 288 496
primary posterior lumbar fusion operations were performed between
1998 and 2008 in the United States. The total number of procedures,
mean patient age and comorbidity burden increased over time. Hospital
length of stay decreased, although the in-hospital mortality (adjusted
and unadjusted for changes in length of hospital stay) remained
stable. However, a significant increase was observed in peri-operative
septic, pulmonary and cardiac complications. Although in-hospital mortality
rates did not change over time in the setting of increases in mean
patient age and comorbidity burden, some major peri-operative complications
increased. These trends highlight the need for appropriate peri-operative services
to optimise outcomes in an increasingly morbid and older population
of patients undergoing lumbar fusion.
Aims. Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. Methods. ASD patients with two-year data were included.
Aims. To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). Methods. We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up.
The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis.Aims
Methods
The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications.Aims
Methods
The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.Aims
Methods
Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS). UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination.Aims
Methods
The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition. Between July 2017 and July 2019, 40 patients with cervical OPLL were equally randomized to undergo surgery with an ACOE or a PTLF. The clinical and radiological results were compared between the two groups.Aims
Methods
The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded.Aims
Methods
Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age. Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.Aims
Methods
The aim of this study was to compare the clinical and radiological outcomes of patients with early-onset scoliosis (EOS), who had undergone spinal fusion after distraction-based spinal growth modulation using either traditional growing rods (TGRs) or magnetically controlled growing rods (MCGRs). We undertook a retrospective review of skeletally mature patients who had undergone fusion for an EOS, which had been previously treated using either TGRs or MCGRs. Measured outcomes included sequential coronal T1 to S1 height and major curve (Cobb) angle on plain radiographs and any complications requiring unplanned surgery before final fusion.Aims
Methods
To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set. AIS patients were systematically enrolled in an institutional registry. In all, 144 AIS patients aged ≤ 25 years undergoing primary surgery (median age 15 years (interquartile range 14 to 17) were included. Patient-reported (condition-specific and health-related quality of life (QoL); functional status; back and leg pain intensity) and clinician-reported outcomes (complications, revision surgery) were recorded. Changes in patient-reported outcome measures (PROMs) were analyzed using Friedman’s analysis of variance. Clinical relevancy was determined using minimally important changes (Scoliosis Research Society (SRS)-22r), cut-off values for relevant effect on functioning (pain scores) and a patient-acceptable symptom state (PASS; Oswestry Disability Index).Aims
Methods
Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires.Aims
Methods
To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae.Aims
Methods
To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded.Aims
Methods
The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively.Aims
Methods
High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique. SRS-22r and full-spine lateral radiographs were collected for the 28 young patients (age 13.4 years (SD 2.6) who underwent surgery for high-grade dysplastic spondylolisthesis in our centre (Scottish National Spinal Deformity Service) between 1995 and 2018. The mean follow-up was nine years (2 to 25), and one patient was lost to follow-up. The standard surgical technique was an all-posterior, partial reduction, and S1 to L5 transfixation screw technique without direct decompression. Parameters for segmental (slip percentage, Dubousset’s lumbosacral angle) and regional alignment (pelvic tilt, sacral slope, L5 incidence, lumbar lordosis, and thoracic kyphosis) and global balance (T1 spino-pelvic inclination) were measured. SRS-22r scores were compared between patients with a balanced and unbalanced pelvis at final follow-up.Aims
Methods
With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected.Aims
Methods
Spinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis. All consecutive skeletally immature patients with idiopathic scoliosis treated with AVBT enrolled in a longitudinal, multicentre, prospective database between 2013 and 2016 were analyzed. All patients were treated by one of two surgeons working at two independent centres. Data were collected prospectively in a multicentre database and supplemented retrospectively where necessary. Patients with a minimum follow-up of two years were included in the analysis. Clinical success was set a priori as a major coronal Cobb angle of < 35° at the most recent follow-up.Aims
Methods
The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation. All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours.Aims
Methods
Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion. A retrospective review of patients treated surgically for Scheuermann’s kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples Aims
Methods
The direct posterior approach with subperiosteal dissection of the paraspinal muscles from the vertebrae is considered to be the standard approach for the surgical treatment of adolescent idiopathic scoliosis (AIS). We investigated whether or not a minimally-invasive surgery (MIS) technique could offer improved results. Consecutive AIS patients treated with an MIS technique at two tertiary centres from June 2013 to March 2016 were retrospectively included. Preoperative patient deformity characteristics, perioperative parameters, power of deformity correction, and complications were studied. A total of 93 patients were included. The outcome of the first 25 patients and the latter 68 were compared as part of our safety analysis to examine the effect of the learning curve.Aims
Methods
It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis. In all, 91 nonambulatory patients with neuromuscular scoliosis were included. All underwent surgery using bilateral, segmental, pedicle screw instrumentation. A total of 40 patients underwent fusion to L5 and 51 had their fixation extended to the pelvis. The two groups were assessed for differences in terms of clinical and radiological findings, as well as complications.Aims
Methods
The aim of this study was to compare the outcomes of surgery
using growing rods in patients with severe A review of a multicentre EOS database identified 107 children
with severe EOS (major curve ≥ 90°) treated with growing rods before
the age of ten years with a minimum follow-up of two years and three
or more lengthening procedures. From the same database, 107 matched
controls with moderate EOS were identified.Aims
Patients and Methods
To evaluate the incidence of primary venous thromboembolism (VTE),
epidural haematoma, surgical site infection (SSI), and 90-day mortality
after elective spinal surgery, and the effect of two protocols for
prophylaxis. A total of 2181 adults underwent 2366 elective spinal procedures
between January 2007 and January 2012. All patients wore anti-embolic
stockings, mobilised early and were kept adequately hydrated. In
addition, 29% (689) of these were given low molecular weight heparin
(LMWH) while in hospital. SSI surveillance was undertaken using the
Centers for Disease Control and Prevention criteria.Aims
Patients and Methods
We undertook a prospective non-randomised radiological study
to evaluate the preliminary results of using magnetically-controlled
growing rods (MAGEC System, Ellipse technology) to treat children
with early-onset scoliosis. Between January 2011 and January 2015, 19 children were treated
with magnetically-controlled growing rods (MCGRs) and underwent
distraction at three-monthly intervals. The mean age of our cohort
was 9.1 years (4 to 14) and the mean follow-up 22.4 months (5.1
to 35.2). Of the 19 children, eight underwent conversion from traditional growing
rods. Whole spine radiographs were carried out pre- and post-operatively:
image intensification was used during each lengthening in the outpatient
department. The measurements evaluated were Cobb angle, thoracic kyphosis,
proximal junctional kyphosis and spinal growth from T1 to S1.Aims
Patients and Methods
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods
Our aim was to perform a systematic review of the literature
to assess the incidence of post-operative epidural haematomas and
wound infections after one-, or two-level, non-complex, lumbar surgery
for degenerative disease in patients with, or without post-operative
wound drainage. Studies were identified from PubMed and EMBASE, up to and including
27 August 2015, for papers describing one- or two-level lumbar discectomy
and/or laminectomy for degenerative disease in adults which reported
any form of subcutaneous or subfascial drainage.Aims
Patients and Methods
The aim of this study was to determine whether
obesity affects pain, surgical and functional outcomes following lumbar
spinal fusion for low back pain (LBP). A systematic literature review and meta-analysis was made of
those studies that compared the outcome of lumbar spinal fusion
for LBP in obese and non-obese patients. A total of 17 studies were
included in the meta-analysis. There was no difference in the pain
and functional outcomes. Lumbar spinal fusion in the obese patient resulted
in a statistically significantly greater intra-operative blood loss
(weighted mean difference: 54.04 ml; 95% confidence interval (CI)
15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio:
1.91; 95% CI 1.68 to 2.18; n = 43858; p <
0.001) and longer duration
of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p <
0.001). Obese
patients have greater intra-operative blood loss, more complications
and longer duration of surgery but pain and functional outcome are
similar to non-obese patients. Based on these results, obesity is
not a contraindication to lumbar spinal fusion. Cite this article:
The aim of this study is to introduce and investigate the efficacy
and feasibility of a new vertebral osteotomy technique, vertebral
column decancellation (VCD), for rigid thoracolumbar kyphotic deformity
(TLKD) secondary to ankylosing spondylitis (AS). We took 39 patients from between January 2009 and January 2013
(26 male, 13 female, mean age 37.4 years, 28 to 54) with AS and
a TLKD who underwent VCD (VCD group) and compared their outcome
with 45 patients (31 male, 14 female, mean age 34.8 years, 23 to
47) with AS and TLKD, who underwent pedicle subtraction osteotomy
(PSO group), according to the same selection criteria. The technique
of VCD was performed at single vertebral level in the thoracolumbar
region of AS patients according to classification of AS kyphotic
deformity. Pre- and post-operative chin-brow vertical angle (CBVA),
sagittal vertical axis (SVA) and sagittal Cobb angle in the thoracolumbar
region were reviewed in the VCD and PSO groups. Intra- , post-operative
and general complications were analysed in both group.Aims
Patients and Methods
The purpose of this prospective study was to evaluate the outcomes
of coccygectomy for patients with chronic coccydynia. Between 2007 and 2011, 98 patients underwent coccygectomy for
chronic coccydynia. The patients were aged >
18 years, had coccygeal
pain, local tenderness and a radiological abnormality, and had failed
conservative management. Outcome measures were the Short Form 36
(SF-36), the Oswestry Disability Index (ODI) and a visual analogue
scale (VAS) for pain. Secondary analysis compared the pre-operative
features and the outcomes of patients with successful and failed
treatment, two years post-operatively. The threshold for success
was based on a minimum clinically important difference (MCID) on
the ODI of 20 points. All other patients, including those lost to
follow-up, were classified as failures.Aims
Patients and Methods
We report the incidence of and risk factors for
complications after scoliosis surgery in patients with Duchenne muscular
dystrophy (DMD) and compare them with those of other neuromuscular
conditions. We identified 110 (64 males, 46 females) consecutive patients
with a neuromuscular disorder who underwent correction of the scoliosis
at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up.
We recorded demographic and peri-operative data, including complications
and re-operations. There were 60 patients with cerebral palsy (54.5%) and 26 with
DMD (23.6%). The overall complication rate was 22% (24 patients),
the most common of which were deep wound infection (9, 8.1%), gastrointestinal
complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication
rate was higher in patients with DMD (10/26, 38.5%) than in those
with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All
hepatotoxicity occurred in patients with DMD (p = 0.003), who also
had an increased rate of deep wound infection (19% In our series, correction of a neuromuscular scoliosis had an
acceptable rate of complications: patients with DMD had an increased
overall rate compared with those with other neuromuscular conditions.
These included deep wound infection and hepatotoxicity. Hepatotoxicity
was unique to DMD patients, and we recommend peri-operative vigilance
after correction of a scoliosis in this group. Cite this article:
The aims of this study were to evaluate the clinical and radiological
outcomes of instrumented posterolateral fusion (PLF) performed in
patients with rheumatoid arthritis (RA). A total of 40 patients with RA and 134 patients without RA underwent
instrumented PLF for spinal stenosis between January 2003 and December
2011. The two groups were matched for age, gender, bone mineral
density, the history of smoking and diabetes, and number of fusion
segments. The clinical outcomes measures included the visual analogue scale
(VAS) and the Korean Oswestry Disability Index (KODI), scored before
surgery, one year and two years after surgery. Radiological outcomes
were evaluated for problems of fixation, nonunion, and adjacent
segment disease (ASD). The mean follow-up was 36.4 months in the RA
group and 39.1 months in the non-RA group.Aims
Methods
We describe 13 patients with cerebral palsy and
lordoscoliosis/hyperlordosis of the lumbar spine who underwent a posterior
spinal fusion at a mean age of 14.5 years (10.8 to 17.4) to improve
sitting posture and relieve pain. The mean follow-up was 3.3 years
(2.2 to 6.2). The mean pre-operative lumbar lordosis was 108° (80
to 150°) and was corrected to 62° (43° to
85°); the mean thoracic kyphosis from 17° (-23° to
35°) to 47° (25° to 65°);
the mean scoliosis from 82° (0° to 125°)
to 22° (0° to 40°); the mean pelvic
obliquity from 21° (0° to 38°)
to 3° (0° to 15°); the mean sacral
slope from 79° (54° to 90°) to
50° (31° to 66°). The mean pre-operative
coronal imbalance was 5 cm (0 cm to 8.9 cm) and was corrected to
0.6 cm (0 to 3.2). The mean sagittal imbalance of -8 cm (-16 cm
to 7.8 cm) was corrected to -1.6 cm
(-4 cm to 2.5 cm). The mean operating time was 250 minutes (180
to 360 minutes) and intra-operative blood loss 0.8 of estimated
blood volume (0.3 to 2 estimated blood volume). The mean intensive
care and hospital stay were 3.5 days (2 to 8) and 14.5 days (10
to 27), respectively. Three patients lost a significant amount of
blood intra-operatively and subsequently developed chest or urinary
infections and superior mesenteric artery syndrome. An increased pre-operative lumbar lordosis and sacral slope were
associated with increased peri-operative morbidity: scoliosis and
pelvic obliquity were not. A reduced lumbar lordosis and increased
thoracic kyphosis correlated with better global sagittal balance
at follow-up. All patients and their parents reported excellent
surgical outcomes. Lordoscoliosis and hyperlordosis are associated with significant
morbidity in quadriplegic patients. They are rare deformities and
their treatment is challenging. Sagittal imbalance is the major
component: it can be corrected by posterior fusion of the spine
with excellent functional results. Cite this article:
Using the United States Nationwide Inpatient
Sample, we identified national trends in revision spinal fusion
along with a comprehensive comparison of comorbidities, inpatient
complications and surgical factors of revision spinal fusion compared
to primary spinal fusion. In 2009, there were 410 158 primary spinal fusion discharges
and 22 128 revision spinal fusion discharges. Between 2002 and 2009,
primary fusion increased at a higher rate compared with revision
fusion (56.4% In the multivariable logistic regression model for all spinal
fusions, depression (odds ratio (OR) 1.53, p <
0.001), psychotic
disorders (OR 1.49, p <
0.001), deficiency anaemias (OR 1.35,
p <
0.001) and smoking (OR 1.10, p = 0.006) had a greater chance
of occurrence in revision spinal fusion discharges than in primary
fusion discharges, adjusting for other variables. In terms of complications,
after adjusting for all significant comorbidities, this study found
that dural tears (OR 1.41; p <
0.001) and surgical site infections
(OR 3.40; p <
0.001) had a greater chance of occurrence in revision
spinal fusion discharges than in primary fusion discharges (p <
0.001). A p-value <
0.01 was considered significant in all final
analyses. Cite this article:
We reviewed 212 consecutive patients with adolescent
idiopathic scoliosis who underwent posterior spinal arthrodesis
using all pedicle screw instrumentation in terms of clinical, radiological
and Scoliosis Research Society (SRS)-22 outcomes. In Group 1 (51
patients), the correction was performed over two rods using bilateral
segmental pedicle screws. In Group 2 (161 patients), the correction
was performed over one rod using unilateral segmental pedicle screws
with the second rod providing stability of the construct
through two-level screw fixation at proximal and distal ends. The
mean age at surgery was
14.8 years in both groups. Comparison between groups showed no significant
differences with regard to age and Risser grade at surgery, pre-
and post-operative scoliosis angle, coronal Cobb correction, length
of hospital stay and SRS scores. Correction of upper thoracic curves
was significantly better in Group 1 (p = 0.02). Increased surgical time
and intra-operative blood loss was recorded in Group 1 (p <
0.001
and p = 0.04, respectively). The implant cost was reduced by mean
35% in Group 2 due to the lesser number of pedicle screws. Unilateral and bilateral pedicle screw techniques have both achieved
excellent deformity correction in adolescent patients with idiopathic
scoliosis, which was maintained at two-year follow-up. This has
been associated with high patient satisfaction and low complication
rates.
We report the results of vertebral column resection
(VCR) for paediatric patients with spinal deformity. A total of
49 VCRs in paediatric patients from four university hospitals between
2005 and 2009 with a minimum two-year follow-up were retrospectively
identified. After excluding single hemivertebral resections (n =
25) and VCRs performed for patients with myelomeningocele (n = 6),
as well as spondylectomies performed for tumour (n = 4), there were
14 patients who had undergone full VCR at a mean age of 12.3 years
(6.5 to 17.9). The aetiology was congenital scoliosis in five, neuromuscular
scoliosis in three, congenital kyphosis in two, global kyphosis
in two, adolescent idiopathic scoliosis in one and secondary scoliosis
in one. A total of seven anteroposterior and seven posterolateral approaches
were used. The mean major curve deformity was 86° (67° to 120°) pre-operatively
and 37° (17° to 80°) at the two-year follow-up; correction was a
mean of 54% (18% to 86%) in the anteroposterior and 60% (41% to
70%) in the posterolateral group at the two-year follow-up (p =
0.53). The mean Scoliosis Research Society-24 total scores were
100 (92 to 108) for the anteroposterior and 102 (95 to 105) for
the posterolateral group. There was one paraparesis in the anteroposterior
group necessitating urgent re-decompression, with a full recovery. Patients undergoing VCR are highly satisfied after a successful
procedure.
This review of the literature presents the current understanding of Scheuermann’s kyphosis and investigates the controversies concerning conservative and surgical treatment. There is considerable debate regarding the pathogenesis, natural history and treatment of this condition. A benign prognosis with settling of symptoms and stabilisation of the deformity at skeletal maturity is expected in most patients. Observation and programmes of exercise are appropriate for mild, flexible, non-progressive deformities. Bracing is indicated for a moderate deformity which spans several levels and retains flexibility in motivated patients who have significant remaining spinal growth. The loss of some correction after the completion of bracing with recurrent anterior vertebral wedging has been reported in approximately one-third of patients. Surgical correction with instrumented spinal fusion is indicated for a severe kyphosis which carries a risk of progression beyond the end of growth causing cosmetic deformity, back pain and neurological complications. There is no consensus on the effectiveness of different techniques and types of instrumentation. Techniques include posterior-only and combined anteroposterior spinal fusion with or without posterior osteotomies across the apex of the deformity. Current instrumented techniques include hybrid and all-pedicle screw constructs.
We evaluated the efficacy of anterior fusion alone compared with combined anterior and posterior fusion for the treatment of degenerative cervical kyphosis. Anterior fusion alone was undertaken in 15 patients (group A) and combined anterior and posterior fusion was carried out in a further 15 (group B). The degree and maintenance of the angle of correction, the incidence of graft subsidence, degeneration at adjacent levels and the rate of fusion were assessed radiologically and clinically and the rate of complications recorded. The mean angle of correction in group B was significantly higher than in group A (p = 0.0009). The mean visual analogue scale and the neck disability index in group B was better than in group A (p = 0.043, 0.0006). The mean operation time and the blood loss in B were greater than in group A (p <
0.0001, 0.037). Pseudarthrosis, subsidence of the cage, and problems related to the hardware were more prevalent in group A than in group B (p = 0.034, 0.025, 0.013). Although the combined procedure resulted in a longer operating time and greater blood loss than with anterior fusion alone, our results suggest that for the treatment of degenerative cervical kyphosis the combined approach leads to better maintenance of sagittal alignment, a higher rate of fusion, a lower incidence of complications and a better clinical outcome.
Conventional growing rods are the most commonly
used distraction-based devices in the treatment of progressive early-onset
scoliosis. This technique requires repeated lengthenings with the
patient anaesthetised in the operating theatre. We describe the
outcomes and complications of using a non-invasive magnetically
controlled growing rod (MCGR) in children with early-onset scoliosis.
Lengthening is performed on an outpatient basis using an external remote
control with the patient awake. Between November 2009 and March 2011, 34 children with a mean
age of eight years (5 to 12) underwent treatment. The mean length
of follow-up was 15 months (12 to 18). In total, 22 children were
treated with dual rod constructs and 12 with a single rod. The mean
number of distractions per patient was 4.8 (3 to 6). The mean pre-operative
Cobb angle was 69° (46° to 108°); this was corrected to a mean 47°
(28° to 91°) post-operatively. The mean Cobb angle at final review
was 41° (27° to 86°). The mean pre-operative distance from T1 to
S1 was 304 mm (243 to 380) and increased to 335 mm (253 to 400)
in the immediate post-operative period. At final review the mean distance
from T1 to S1 had increased to 348 mm (260 to 420). Two patients developed a superficial wound infection and a further
two patients in the single rod group developed a loss of distraction.
In the dual rod group, one patient had pull-out of a hook and one
developed prominent metalwork. Two patients had a rod breakage;
one patient in the single rod group and one patient in the dual
rod group. Our early results show that the MCGR is safe and effective
in the treatment of progressive early-onset scoliosis with the avoidance
of repeated surgical lengthenings. Cite this article:
We reviewed 31 consecutive patients with Friedreich’s
ataxia and scoliosis. There were 24 males and seven females with
a mean age at presentation of 15.5 years (8.6 to 30.8) and a mean
curve of 51° (13° to 140°). A total of 12 patients had thoracic
curvatures, 11 had thoracolumbar and eight had double thoracic/lumbar.
Two patients had long thoracolumbar collapsing scoliosis with pelvic
obliquity and four had hyperkyphosis. Left-sided thoracic curves in
nine patients (45%) and increased thoracic kyphosis differentiated
these deformities from adolescent idiopathic scoliosis. There were
17 patients who underwent a posterior instrumented spinal fusion
at mean age of 13.35 years, which achieved and maintained good correction
of the deformity. Post-operative complications included one death due
to cardiorespiratory failure, one revision to address nonunion and
four patients with proximal junctional kyphosis who did not need
extension of the fusion. There were no neurological complications
and no wound infections. The rate of progression of the scoliosis
in children kept under simple observation and those treated with bracing
was less for lumbar curves during bracing and similar for thoracic
curves. The scoliosis progressed in seven of nine children initially
treated with a brace who later required surgery. Two patients presented
after skeletal maturity with balanced curves not requiring correction.
Three patients with severe deformities who would benefit from corrective
surgery had significant cardiac co-morbidities.
Posterior lumbar interbody fusion (PLIF) is indicated
for many patients with pain and/or instability of the lumbar spine.
We performed 36 PLIF procedures using the patient’s lumbar spinous
process and laminae, which were inserted as a bone graft between
two vertebral bodies without using a cage. The mean lumbar lordosis
and mean disc height to vertebral body ratio were restored and preserved
after surgery. There were no serious complications. These results suggest that this procedure is safe and effective.
The optimal timing of percutaneous vertebroplasty
as treatment for painful osteoporotic vertebral compression fractures
(OVCFs) is still unclear. With the position of vertebroplasty having
been challenged by recent placebo-controlled studies, appropriate
timing gains importance. We investigated the relationship between the onset of symptoms
– the time from fracture – and the efficacy of vertebroplasty in
115 patients with 216 painful subacute or chronic OVCFs (mean time
from fracture 6.0 months ( It was found that there was an immediate and sustainable improvement
in the level of back pain and HRQoL after vertebroplasty, which
was independent of the time from fracture. Greater time from fracture
was associated with neither worse pre-operative conditions nor increased
vertebral deformity, nor with the presence of an intravertebral cleft. We conclude that vertebroplasty can be safely undertaken at an
appropriate moment between two and 12 months following the onset
of symptoms of an OVCF.
Vertebral compression fractures are the most prevalent complication of osteoporosis and percutaneous vertebroplasty (PVP) has emerged as a promising addition to the methods of treating the debilitating pain they may cause. Since PVP was first reported in the literature in 1987, more than 600 clinical papers have been published on the subject. Most report excellent improvements in pain relief and quality of life. However, these papers have been based mostly on uncontrolled cohort studies with a wide variety of inclusion and exclusion criteria. In 2009, two high-profile randomised controlled trials were published in the
We describe the results of a prospective case series of patients with spondylolysis, evaluating a technique of direct stabilisation of the pars interarticularis with a construct that consists of a pair of pedicle screws connected by a U-shaped modular link passing beneath the spinous process. Tightening the link to the screws compresses bone graft in the defect in the pars, providing rigid intrasegmental fixation. We have carried out this procedure on 20 patients aged between nine and 21 years with a defect of the pars at L5, confirmed on CT. The mean age of the patients was 13.9 years (9 to 21). They had a grade I or less spondylolisthesis and no evidence of intervertebral degeneration on MRI. The mean follow-up was four years (2.3 to 7.3). The patients were assessed by the Oswestry Disability Index (ODI) and a visual analogue scale (VAS). At the latest follow-up, 18 patients had an excellent clinical outcome, with a significant (p <
0.001) improvement in their ODI and VAS scores. The mean ODI score at final follow-up was 8%. Assessment of the defect by CT showed a rate of union of 80%. There were no complications involving the internal fixation. The strength of the construct removes the need for post-operative immobilisation.
We describe a modified technique of micro-decompression of the lumbar spine involving the use of an operating microscope, a malleable retractor and a high-speed burr, which allows decompression to be performed on both sides of the spine through a unilateral, hemi-laminectomy approach. The first 100 patients to be treated with this technique have been evaluated prospectively using a visual analogue score for sciatica and back pain, the MacNab criteria for patient satisfaction, and functional assessment with the Oswestry Disability Index. After a period of follow-up from 12 months to six years and four months, sciatica had improved in 90 patients and back pain in 84 patients. Their result was graded as good or excellent by 82 patients according to the MacNab criteria, and 75 patients had subjective improvement in their walking distance. Late instability developed in four patients. Lumbar micro-decompression has proved to be safe, with few complications. Postoperative instability requiring fusion was uncommon, and less than using traditional approaches in published series.
Between January 1990 and December 2000 we carried out 226 SB Charité III disc replacements for lumbar disc degeneration in 160 patients. They were reviewed at a mean follow-up of 79 months (31 to 161) to determine the clinical and radiological outcome. The clinical results were collected by an independent observer, who was not involved in patient selection, treatment or follow-up, using a combination of outcome measures, including the Oswestry Disability Index. Pain was recorded using a visual analogue score, and the most recent radiographs were reviewed. Survival of the device was analysed by the Kaplan-Meier method and showed a cumulative survival of 35% at 156 months when radiological failure was taken as the endpoint. The mean improvement in the Oswestry disability index scores after disc replacement was 14% (6% to 21%) and the mean improvement in the pain score was 1.6 (0.46 to 2.73), both falling below the clinically significant threshold. Removal of the implant was required in 12 patients, four because of implant failure. These poor results indicate that further use of this implant is not justified.
We present the clinical and radiological results of percutaneous vertebroplasty in the treatment of 58 vertebral compression fractures in 51 patients at a minimum follow-up of two years. Group 1 consisted of 39 patients, in whom there was no associated intravertebral cleft, whilst group 2 comprised 12 patients with an intravertebral cleft. The Oswestry disability index (ODI) and visual analogue scale (VAS) scores were recorded prospectively. The radiological evidence of kyphotic deformity, vertebral height, leakage of cement and bone resorption around the cement were studied restrospectively, both before and after operation and at the final follow-up. The ODI and VAS scores in both groups decreased after treatment, but the mean score in group 2 was higher than that in group 1 (p = 0.02 (ODI), p = 0.02 (VAS)). There was a greater initial correction of the kyphosis in group 2 than in group 1, although the difference was not statistically significant. However, loss of correction was greater in group 2. Leakage of cement was seen in 24 (41.4%) of 58 vertebrae (group 1, 32.6% (15 of 46); group 2, 75% (9 of 12)), mainly of type B through the basal vertebral vein in group 1 and of type C through the cortical defect in group 2. Resorption of bone around the cement was seen in three vertebrae in group 2 and in one in group 1. There were seven adjacent vertebral fractures in group 1 and one in group 2. Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures with or without an intravertebral cleft. Nonetheless, higher rates of complications related to the cement must be recognised in patients in the presence of an intravertebral cleft.
We evaluated the use of surgical stabilisation for atlantoaxial subluxation after a follow-up of 24 years in 50 rheumatoid patients who had some degree of pain but no major neurological deficit. The mortality of patients treated by atlantoaxial fusion was significantly lower than for those who received conservative treatment. The deaths resulted from infection or comorbid conditions. The significantly high relative risks of mortality from conservative treatment compared with surgical treatment were mutilating disease and susceptible factors on both of the HLA-DRB1 alleles. Relief from pain and neurological and functional recovery were better, and the radiological degree of atlantoaxial translocation was less in those who were surgically treated compared with those who were not. Two patients had superficial local infections after surgery. We conclude that prophylactic atlantoaxial fusion is better than conservative treatment in these patients.
Multiple thoracic disc herniations are rare and there are few reports in the literature. Between December 1998 and July 2002, we operated on 12 patients with multiple thoracic disc herniations. All underwent an anterior decompression and fusion through a transthoracic approach. The clinical outcomes were assessed using the Frankel neurological classification and the Japanese Orthopaedic Association (JOA) score. Under the Frankel classification, two patients improved by two grades (C to E), one patient improved by one grade (C to D), while nine patients who had been classified as grade D did not change. The JOA scores improved significantly after surgery with a mean recovery rate of 44.8% ± 24.5%. Overall, clinical outcomes were excellent in two patients, good in two, fair in six and unchanged in two. Our results indicate that anterior decompression and fusion for multiple thoracic disc herniations through a transthoracic approach can provide satisfactory results.
We present data relating to the Bryan disc arthroplasty for the treatment of cervical spondylosis in 46 patients. Patients with either radiculopathy or myelopathy had a cervical discectomy followed by implantation of a cervical disc prosthesis. Patients were reviewed at six weeks, six months and one year and assessment included three outcome measures, a visual analogue scale (VAS), the short form 36 (SF-36) and the neck disability index (NDI). The results were categorised according to a modification of Odom’s criteria. Radiological evaluation, by an independent radiologist, sought evidence of movement, stability and subsidence of the prosthesis. A highly significant difference was found for all three outcome measurements, comparing the pre-operative with the post-operative values: VAS (Z = 6.42, p <
0.0001), SF-36 (mental component) (Z = −5.02, p <
0.0001), SF-36 (physical component) (Z = −5.00, p <
0.0001) and NDI (Z = 7.03, p <
0.0001). The Bryan cervical disc prosthesis seems reliable and safe in the treatment of patients with cervical spondylosis.