Outcome of posterior decompression and posterior stabilisation in dorsolumbar spinal fractures

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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Linear craniectomy for early posterior decompression in craniosynostoses: technique and results

Child s Nervous System ◽

10.1007/s00381-021-05117-8 ◽

2021 ◽

Author(s):

Matthieu Vinchon ◽

Pierre Guerreschi ◽

Melodie-Anne Karnoub ◽

Alexis Wolber

Keyword(s):

Posterior Decompression

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413 Posterior Stabilisation Without Formal Debridement for The Treatment of Non-Tuberculous Pyogenic Spinal Infection in A Frail and Debilitated Population – A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab134.275 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Elmajee ◽

C Munasinghe ◽

A Aljawadi ◽

K Elawady ◽

F Shuweihde ◽

...

Keyword(s):

Posterior Approach ◽

Meta Analysis ◽

Spinal Infection ◽

Spinal Instability ◽

Surgical Interventions ◽

Spine Tango ◽

Neurological Outcomes ◽

Neurological Improvement ◽

Posterior Stabilisation ◽

Successful Infection

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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Vertebral Metastasis Treated by Vertebroplasty, a Cause of Respiratory Failure: Case Report and Literature Review

Case Reports in Oncology ◽

10.1159/000513492 ◽

2021 ◽

pp. 279-283

Author(s):

Mathieu Chevallier ◽

Chloé Chevallier-Lugon ◽

Alex Friedlaender ◽

Alfredo Addeo

Keyword(s):

Spinal Fractures ◽

Safe Procedure ◽

Vertebral Metastasis ◽

Minimally Invasive Surgical Procedure ◽

Venous Circulation ◽

Minimally Invasive Surgical ◽

Life Threatening ◽

Frequent Site ◽

The Right ◽

Substantial Morbidity

Bone is a frequent site of metastases in advanced cancers including lung, breast, prostate, kidney, or myeloma. Lesions are commonly located on the spine. Neoplastic invasion of the vertebral body can result in painful vertebral fractures, leading to disability and substantial morbidity. Percutaneous vertebroplasty is a minimally invasive surgical procedure used to treat spinal fractures due to osteolytic tumors. It could result in pain reduction or resolution in 80–90% of patients with fractures, and it improves stability. Although considered safe, vertebroplasty has been associated over the years with life-threatening complications. We have reported the case of a 55-year-old patient with lung adenocarcinoma, who underwent vertebroplasty for a pathological neoplastic fracture of L2. The procedure was complicated by a leak of cement into the systemic venous circulation, characterized by an 11-cm filament in the right heart chambers and multiple pulmonary emboli. To our knowledge, only one similar case was previously reported, involving an intracardiac cement filament longer than 10 cm. The data are scant, hence the importance of collecting and reporting possible complications about what is perceived as a rather safe procedure. The case highlights the need for a robust postprocedure imaging plan to detect complications, which can impact patients’ morbidity and survival.

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Early Versus Late Spine Surgery in Severely Injured Patients—Which Is the Appropriate Timing for Surgery?

Global Spine Journal ◽

10.1177/2192568221989292 ◽

2021 ◽

pp. 219256822198929

Author(s):

Arnaldo Sousa ◽

Cláudia Rodrigues ◽

Luís Barros ◽

Pedro Serrano ◽

Ricardo Rodrigues-Pinto

Keyword(s):

Mortality Rate ◽

Spinal Fractures ◽

Simplified Acute Physiology Score ◽

Neurological Injury ◽

Spine Fractures ◽

Severely Injured ◽

Intubation Time ◽

Severely Injured Patients ◽

Level Of Evidence ◽

Injured Patients

Study Design: Retrospective cohort study conducted at tertiary spinal trauma referral center. Objective: We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. Methods: The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as “early surgeries.” Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. Results: Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. Conclusions: Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. Level of Evidence of the Study: Level III.

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Transpedicular Drainage of Presacral Abscess and Posterior Decompression of Acute Cauda Equina Syndrome in Caries Spine

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3181ecf873 ◽

2011 ◽

Vol 24 (3) ◽

pp. E26-E30 ◽

Cited By ~ 5

Author(s):

Sumit Arora ◽

Ramesh Kumar ◽

Sumit Batra ◽

Rohit Nath

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Posterior Decompression ◽

Caries Spine ◽

Presacral Abscess

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Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study

Operative Neurosurgery ◽

10.1093/ons/opx043 ◽

2017 ◽

Vol 13 (6) ◽

pp. 661-669 ◽

Cited By ~ 10

Author(s):

Shiro Imagama ◽

Kei Ando ◽

Kazuyoshi Kobayashi ◽

Tetsuro Hida ◽

Kenyu Ito ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Outcomes ◽

Ligamentum Flavum ◽

Posterior Longitudinal Ligament ◽

Neurophysiological Monitoring ◽

Posterior Decompression ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Estimated Blood Loss ◽

Significant Factors

Abstract BACKGROUND Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE To identify factors for good surgical outcomes with prospective and comparative study. METHODS Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and <50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P < .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

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