Iatrogenic Spinal Instability

Abstract Background Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure focuses on the anterior approach with aggressive debridement of the infected tissue regions. We aim to evaluate the effectiveness of the posterior approach without debridement. Method Several databases including MEDLINE, NHS evidence and the Cochrane database were searched. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Results From the four papers included in the meta-analysis, post-operative pain levels were found to be lower at a statistically significant level when a random effects model was applied, with the effect size found to be at 0.872 (p < 0.001, 95% CI: 0.7137 to 1.0308). Post-surgical neurological improvement was also demonstrated with a mean FGS improvement of 1.12 in 64 patients over the included articles. Conclusions Posterior approach with posterior stabilisation without formal debridement can results in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration are strongly recommended.

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The Risk of Vertebral Compression Fracture (VCF) Postspine Stereotactic Body Radiation Therapy (SBRT) and Evaluation of the Spinal Instability Neoplastic Score (SINS)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.108 ◽

2012 ◽

Vol 84 (3) ◽

pp. S39-S40

Author(s):

A. Al-Omair ◽

M. da Cunha ◽

E. Atenafu ◽

D. Letourneau ◽

R. Korol ◽

...

Keyword(s):

Radiation Therapy ◽

Vertebral Compression Fracture ◽

Stereotactic Body Radiation Therapy ◽

Compression Fracture ◽

Spinal Instability ◽

Stereotactic Body Radiation

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Vertebral fractures and luxations in dogs and cats part 2: treatment and surgery options

Companion Animal ◽

10.12968/coan.2020.0027b ◽

2021 ◽

Vol 26 (3) ◽

pp. 15-19

Author(s):

Ivona Orgonikova ◽

Josep Brocal ◽

Giunio Bruto Cherubini ◽

Viktor Palus

Keyword(s):

Spinal Cord ◽

Vertebral Fractures ◽

Vertebral Column ◽

Compartment Model ◽

Spinal Instability ◽

Decompression Surgery ◽

Implant Loosening ◽

Bone Fragment ◽

Three Compartment Model ◽

Disc Extrusion

Assessing the presence of vertebral column instability is essential in animals with vertebral fractures or luxations. Spinal instability is most commonly assessed using a three-compartment model and unstable vertebral fractures and luxations require surgical stabilisation. In cases of compression of the spinal cord (by haematoma, traumatic intervertebral disc extrusion or bone fragment), decompression surgery is necessary. Prompt surgery prevents additional spinal cord damage, but the overall condition of the patient, including any concurrent injuries, needs to be continually kept in mind. The vertebral column can be stabilised using multiple techniques, such as screws, pins, polymethylmetacrylate and plating techniques, as well as external stabilisation and spinal stapling. Complications of spinal surgeries include haemorrhage, infection, neurological deterioration, particularly in cases of spinal stabilisations, implant loosening and failure.

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Vertebral compression fracture rate following stereotactic ablative body radiotherapy for spine oligometastases: a UK experience

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000224 ◽

2021 ◽

pp. 1-5

Author(s):

Sameed Hussain ◽

Anjali Zarkar ◽

Ahmed Elmodir ◽

Daniel Ford ◽

Sundus Yahya ◽

...

Keyword(s):

Vertebral Compression Fracture ◽

Demographic Data ◽

Spinal Metastases ◽

Compression Fracture ◽

Spinal Instability ◽

Fracture Rate ◽

Strict Adherence ◽

Stereotactic Ablative Body Radiotherapy ◽

Vertebral Bodies ◽

Pre Treatment

Abstract Aim: Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these. Materials and methods: A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF. Results: A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed. Findings: SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.

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A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.98.3.0290 ◽

2003 ◽

Vol 98 (3) ◽

pp. 290-293 ◽

Cited By ~ 8

Author(s):

Koichi Sairyo ◽

Shinsuke Katoh ◽

Tadanori Sakamaki ◽

Shinji Komatsubara ◽

Natsuo Yasui

Keyword(s):

Clinical Outcome ◽

Nerve Root ◽

Clinical Results ◽

Skin Incision ◽

Endoscopic Technique ◽

Spinal Instability ◽

Nerve Roots ◽

Content Type ◽

Proximal Stump

✓ The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42–70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.

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Epidemiology of spinal cord and column tumors

Neuro-Oncology Practice ◽

10.1093/nop/npaa046 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. i5-i9

Author(s):

Joshua T Wewel ◽

John E O’Toole

Keyword(s):

Spinal Cord ◽

Treatment Options ◽

Survival Rates ◽

Spinal Metastases ◽

Cord Compression ◽

Severe Form ◽

Spinal Instability ◽

Treatment Cascade ◽

Tumor Pathology ◽

Pathologic Fractures

Abstract The spine is a frequent location for metastatic disease. As local control of primary tumor pathology continues to improve, survival rates improve and, by extension, the opportunity for metastasis increases. Breast, lung, and prostate cancer are the leading contributors to spinal metastases. Spinal metastases can manifest as bone pain, pathologic fractures, spinal instability, nerve root compression, and, in its most severe form, spinal cord compression. The global extent of disease, the spinal burden, neurologic status, and life expectancy help to categorize patients as to their candidacy for treatment options. Efficient identification and workup of those with spinal metastases will expedite the treatment cascade and improve quality of life.

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Operative management of traumatic cervical spine distraction and complete cord transection in a 3-year-old patient

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14242 ◽

2015 ◽

Vol 15 (2) ◽

pp. 214-219 ◽

Cited By ~ 2

Author(s):

Monica Salazar Davern ◽

Sumeet Garg ◽

Todd C. Hankinson

Keyword(s):

Spinal Cord ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Cervical Spinal Cord ◽

Young Patients ◽

Operative Management ◽

Neurological Deficits ◽

Spinal Instability ◽

Ethical Challenges ◽

Vehicle Accident

This report describes the presentation and operative treatment of a 3-year-old boy who survived a motor vehicle accident that resulted in a C6–7 distraction injury, complete avulsion of the spinal cord, and gross spinal instability. Only 5%–10% of all spinal cord and vertebral column injuries occur in children. Survival after such an injury is exceptionally rare in very young patients and is associated with severe neurological deficits. The authors discuss the substantial ethical challenges involved in the care of a patient with this injury. To their knowledge, only two other cases of survival have been reported in pediatric patients following motor vehicle trauma resulting in complete injury to the lower cervical spinal cord.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14271 ◽

2014 ◽

Vol 21 (1) ◽

pp. 48-53 ◽

Cited By ~ 34

Author(s):

Jeffrey C. Wang ◽

Andrew T. Dailey ◽

Praveen V. Mummaneni ◽

Zoher Ghogawala ◽

Daniel K. Resnick ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Lumbar Fusion ◽

Signs And Symptoms ◽

Herniated Disc ◽

Spinal Instability ◽

Low Back ◽

Low Level ◽

Disc Herniations

Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.

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