Long-Term Follow-Up Results of Thoracolumbar Fractures After Posterior Instrumentation

Object As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. Methods Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. Conclusions Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.

Download Full-text

Long-term follow-up results in patients with thoracolumbar unstable burst fracture treated with temporary posterior instrumentation without fusion and implant removal surgery

Medicine ◽

10.1097/md.0000000000019780 ◽

2020 ◽

Vol 99 (16) ◽

pp. e19780

Author(s):

Sangbong Ko ◽

Sukhan Jung ◽

Sukkyoon Song ◽

Jun-Young Kim ◽

Jaibum Kwon

Keyword(s):

Posterior Instrumentation ◽

Burst Fracture ◽

Implant Removal ◽

Long Term Follow Up

Download Full-text

Analysis of Cervical Sagittal Alignment After Screw-Rod Fixation

Neurosurgery ◽

10.1227/neu.0b013e31828e20ff ◽

2013 ◽

Vol 72 (6) ◽

pp. 983-922 ◽

Cited By ~ 3

Author(s):

Robert F. Heary ◽

Osamah J. Choudhry ◽

Devesh Jalan ◽

Nitin Agarwal

Keyword(s):

Computed Tomography ◽

Sagittal Alignment ◽

Posterior Instrumentation ◽

Deformity Correction ◽

Magnetic Resonance Images ◽

Cervical Sagittal Alignment ◽

Computed Tomography Scans ◽

Long Term Follow Up

Abstract BACKGROUND: The use of posterior instrumentation constructs is well established for subaxial cervical stabilizations/fusions. The importance of global and regional sagittal alignment has become increasingly recognized. OBJECTIVE: To perform an analysis using computed tomography scans to determine the effect of posterior instrumentation on postoperative cervical sagittal alignment at long-term follow-up. METHODS: Over a period of 6 years, 56 consecutive patients (38 male and 18 female patients; mean age, 47 years) underwent cervical screw-rod fixation. Plain radiographs, computed tomography scans, and magnetic resonance images were analyzed preoperatively to assess sagittal alignment (C2-C7). Postoperatively, computed tomography scans and serial radiographs were obtained in all patients. With the use of independent observers, changes in sagittal alignment were determined by comparing the preoperative and postoperative imaging studies. RESULTS: In total, 390 screws were placed in the cervical spines of 56 patients. Definitive radiographic fusion was detected in all 56 patients (100%). There were no incidences of instrumentation failures or lucencies surrounding any screws. Patients with preoperative kyphosis (n = 19; mean, +9.9°) improved their sagittal alignment by 6.5° (final mean, +3.4°), whereas patients with preoperative lordosis (n = 37; mean −15.44°) maintained their lordosis (final mean, −15.3°). Mean duration of follow-up was 32.5 months. CONCLUSION: Radiographic analysis showed lateral mass fixation to be safe and effective. Certain operative techniques allowed substantial deformity correction and maintenance of long-term correction of deformity. Screw-rod fixation may be an effective method for maintaining lordotic cervical alignment in previously lordotic patients and for significantly correcting kyphotic deformity in patients with a preoperative kyphosis.

Download Full-text

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Download Full-text