LATERAL CAVITATORY APPROACH WITH CIRCUMSPINAL DECOMPRESSION IN TUBERCULOUS SPONDYLITIS: A 5YR FOLLOW-UP STUDY

2019 ◽  
pp. 1-3
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Spinal Tuberculosis ◽  
Thoracolumbar Spine ◽  
Spinal Instrumentation ◽  
Posterior Spinal Fusion ◽  
Neurological Complications ◽  
Single Stage ◽  
Laboratory Findings

Introduction: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antituberculous drugs to radical surgical extirpation. Opinion is divided on management of Potts Paraplegia with respect to surgical approach to the lesion. Results are conflicting on anterior verses posterior approaches as well combined approach. There is also confusion on to when to do anterior first or to operate from posterior first, in combined approaches. In the present study we present 10 year follow-up of our results, clinical and radiological outcomes, of Single stage Circumspinal decompression and pedicle screw fixation through lateral extracavitatory approach with anterior and posterior spinal fusion in cases of Pott's paraplegia. Methods:The study was a retrospective and prospective follow up of 30 patients with active tuberculosis of thoracolumbar spine with neurological deficit, who underwent posterior spinal instrumentation with lateral extra cavitatory approach with circumspinal decompression and pedicle screw instrumentation. Diagnosis of spinal tuberculosis was made by laboratory findings such as anaemia, elevated ESR, radiological features with typical MR imaging findings. 8 patients had multilevel involvement. Kyphosis of 250 to 550 was present. Circumspinal decompression, correction of kyphosis, anterior and posterior spinal fusion was performed in a single stage. The average follow up was 7.67 years (92 months). Results: The mean kyphosis angle improved from 320 preoperatively to 80 in early follow up, followed by a minor loss of correction of 30. Neurological recovery occurred in 28 patients out of 30 patients. 15 patients recovered from Asia A to AIS E. 13 patients recovered to ASIA D. The visual analog scale and ASIA grade improved in all the cases. Implant failure in the form of rod breakage was seen in 1 patient but with no neurological complications. Conclusion: Drainage of abscess, debridement by extracavitatory route constitutes a less demanding, relatively safe, minimally traumatic operative technique with adequate circumspinal decompression of spinal cord, correction and maintenance of sagittal balance with relatively less morbidity is the added advantage.

scholarly journals Posterior Spinal Fusion Extended to Stable Vertebra Provides Similar Outcome in Juvenile Idiopathic Scoliosis Patients Compared with Adolescents with Fusion to the Touched Vertebra

2018 ◽  
Vol 108 (1) ◽  
pp. 83-89 ◽  
Author(s):  
H. Oksanen ◽  
M. Lastikka ◽  
L. Helenius ◽  
O. Pajulo ◽  
I. Helenius
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pedicle Screw ◽  
Posterior Spinal Fusion ◽  
Research Society ◽  
Adolescent Group ◽  
Scoliosis Research Society ◽  
Juvenile Idiopathic Scoliosis

Background and Aims: To compare outcomes between posterior spinal fusion of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis patients with a minimum of 2-year follow-up. The juvenile idiopathic scoliosis patients were fused to the stable vertebra and adolescent idiopathic scoliosis to the touched vertebra. We hypothesized that extending the spinal fusion to the stable vertebra in juvenile patients would provide similar outcomes compared with fusion to the touched vertebra in adolescents. Materials and Methods: A prospective comparative study of 21 consecutive children with juvenile (Risser 0) and 84 adolescent (Risser ⩾2) idiopathic scoliosis (1:4 ratio) undergoing bilateral segmental pedicle screw instrumentation and direct vertebral derotation with a minimum of 2-year follow-up. Results: Juvenile patients had a significantly larger main curve (58° vs 53°, p = 0.003), more fused levels (p = 0.012) and posterior column osteotomies (p = 0.014) than adolescent patients. Distal adding-on (>10°) was observed in one (4.7%) juvenile and three (3.6%) adolescent patients (p = 0.80), without the need for revisions. Scoliosis Research Society 24 total score averaged 101 in juvenile and 97 in adolescent group at 2-year follow-up (p = 0.047). Conclusion: Posterior spinal fusion with bilateral segmental pedicle screw instrumentation to the stable vertebra provides similar clinical and radiographic outcomes in juvenile patients as compared with adolescents with fusion to the touched vertebra in idiopathic scoliosis. Health-related quality of life as measured using the Scoliosis Research Society 24 questionnaire at the end of follow-up was better in the juvenile as compared with the adolescent group.

scholarly journals GAIT DISORDERS IN PATIENTS WITH INSTRUMENTED NEUROMUSCULAR SCOLIOSIS

2019 ◽  
Vol 18 (4) ◽  
pp. 272-275
Author(s):  
Carlos Duncan ◽  
Sebastian Maenza ◽  
Cecilia Schmid ◽  
Eduardo Segal ◽  
Juan Couto
Keyword(s):  
Spinal Fusion ◽  
Spinal Instrumentation ◽  
Posterior Spinal Fusion ◽  
Neuromuscular Scoliosis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
Ambulatory Patients ◽  
Control Study

ABSTRACT Introduction: The effect of spinal fusion on gait in patients with neuromuscular scoliosis continues to be a controversial issue, especially in patients where the spinal fusion extends to the pelvis. Objective: To evaluate the effect of spinal instrumentation in these patients. Methods: We evaluated 34 patients in a retrospective study. The mean age at surgery was 14±3 years and only ambulatory patients who presented neuromuscular scoliosis and non-progressing neurogenic pathology were included. The patients were surgically treated by posterior spinal fusion with or without extension to the pelvis. Preoperative (PRE) and postoperative (POP) Rx were measured. Ambulatory potential was clinically examined in all the patients, and 10 patients were assessed by full-gait analysis. Results: The minimum POP follow-up was 2 years (2006-2016). Nine patients were instrumented to the pelvis when the obliquity was greater than 15°; the remaining patients were treated using the same fusion-level criteria as those applied for idiopathic scoliosis. All patients maintained their gait, with improvements in coronal and sagittal balance, transfers and sitting skills, physical appearance, and in some cases, gait speed. Conclusions: Spinal instrumentation in ambulatory patients with neuromuscular scoliosis, including procedures with extension to the pelvis, provides adequate correction and preserves ambulatory function. Level of evidence III; Retrospective case control study.

Late spinal infections following posterior spinal fusion in pediatric deformities: treatment using single-stage titanium implant exchange

2021 ◽  
Author(s):  
Bijan Ameri ◽  
Harry L. Shufflebarger ◽  
Emerson Blaze ◽  
Jahangir Asghar ◽  
Stephen G. George ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Titanium Implant ◽  
Posterior Spinal Fusion ◽  
Single Stage ◽  
Spinal Infections

scholarly journals Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

2021 ◽  
Author(s):  
Patro Kumar Susanta ◽  
Nayak Biswaranjan ◽  
Krishnamurthy Holeppagol Balappa ◽  
Arun Kumar ◽  
Debabrata Biswal ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Thoracolumbar Spine ◽  
Single Stage ◽  
Posterior Stabilization ◽  
Surgical Interventions ◽  
Antitubercular Drugs ◽  
Impairment Score ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

scholarly journals Delayed Dural Leak Following Posterior Spinal Fusion for Idiopathic Scoliosis Using All Posterior Pedicle Screw Technique

2017 ◽  
Vol 37 (7) ◽  
pp. e415-e420 ◽  
Author(s):  
Lorena V. Floccari ◽  
A. Noelle Larson ◽  
Anthony A. Stans ◽  
Jeremy Fogelson ◽  
Iikka Helenius
Keyword(s):  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pedicle Screw ◽  
Posterior Spinal Fusion ◽  
Dural Leak

Nonstructural versus structural bone grafting in the treatment of lumbar spinal tuberculosis combined with single-stage posterior debridement and instrumentation: a retrospective cohort study

2020 ◽  
Author(s):  
Zenghui Zhao ◽  
Jianxiao Li ◽  
Qiqi Peng ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Single Stage ◽  
Anterior Column ◽  
Bone Fusion ◽  
Anterior Column Support ◽  
Lumbar Spinal ◽  
Posterior Debridement

Abstract Background Many types of bone grafting have been reported for successful use in achieving anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the feasibility of none-structural bone grafting from comparing the advantages and disadvantages with structural bone grafting in the treatment of lumbar spinal tuberculosis. Patients and methods We retrospectively reviewed patients with lumbar spinal tuberculosis who had undergone none-structural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for back pain, the Oswestry Disability Index were collated before surgery and at follow-up. Results Both none-structural and structural bone grafting were associated with significant improvements in quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was in both two groups, without any associated complications. The operation duration and blood loss in none-structural bone grafting group was significantly less. The bone fusion rate was higher in structural bone grafting group. There were three complications in the none-structural bone grafting and four complications in the structural bone grafting group; the incidence of complications between the two groups was not significantly different. Conclusions Based on single-stage posterior debridement and pedicle screws fixation, none-structural bone grafting can achieve anterior column support with reducing surgical trauma, simplifying surgical procedure and decreasing intraoperative hemorrhage, but the lower rate of grafted bone fusion should be taken into consideration when choosing the aforementioned method. Key words Lumbar spinal tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; None-structural bone grafting; Structural bone grafting

scholarly journals Releasing the tether: Weight normalization following corrective spinal fusion in cerebral palsy

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878255 ◽  
Author(s):  
Christopher J DeFrancesco ◽  
Daniel J Miller ◽  
Patrick J Cahill ◽  
David A Spiegel ◽  
John M Flynn ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cerebral Palsy ◽  
Weight Gain ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Abdominal Pressure ◽  
Level Of Evidence ◽  
Feeding Difficulties ◽  
Weight Percentile

Purpose: Feeding difficulties are common among patients with cerebral palsy (CP) and neuromuscular (NM) scoliosis. We theorize that posterior spinal fusion (PSF) reduces intra-abdominal pressure, resulting in improved feeding and subsequent weight gain. We hypothesized that, among nonambulatory patients with CP and NM scoliosis, we would observe significant gain in weight following PSF. Methods: Fifty subjects with nonambulatory CP who underwent PSF for NM scoliosis were included. Age and weight were recorded for the preoperative year; on the day of surgery; and at 6-month, 1-year, and 2-year follow-up. Weights were converted to weight percentiles using CP-specific growth charts. The weight percentile distributions were compared between time points using descriptive statistics as well as regression analysis. Results: The average change in weight from the day of surgery to 2-year follow-up was +3.4 percentiles. Patients who started out under the 50th percentile gained an average of 17.3 percentiles in the first year after PSF ( p = 0.009). Regression analysis showed that patients with baseline weight <50th percentile tended to gain in weight percentile over the first postoperative year ( β = 1.990, p = 0.001). No trend was present among this group prior to surgery ( p = 0.692) or during the second postoperative year ( p = 0.945). No trends were noted prior to or after surgery for patients with baseline weights ≥50th percentile. No significant association was observed between curve severity (measured by preoperative Cobb angle) and weight change. Conclusions: This series is the first to document significant weight gain after PSF for NM scoliosis, supporting the theory that spinal correction improves digestive function. Level of Evidence: Prognostic level II.

scholarly journals EVALUATION OF THE RESULTS OF THE USE OF VEPTR IN PATIENTS WITH SCOLIOSIS

2016 ◽  
Vol 15 (3) ◽  
pp. 181-185
Author(s):  
JOÃO PAULO SILVA ARAÚJO ◽  
MARCOS ANDRÉ COSTA FERREIRA ◽  
ANDRÉ FLAVIO FREIRE PEREIRA ◽  
TULIO ALBUQUERQUE DE MOURA RANGEL ◽  
RODRIGO CASTRO DE MEDEIROS ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Spinal Instrumentation ◽  
Objective Evaluation ◽  
Complication Rates ◽  
Mean Values ◽  
Fusion Methods ◽  
The Mean ◽  
Getulio Vargas ◽  
Initial Correction

ABSTRACT Objective: Evaluation of the results of the use of VEPTR (Vertical Expandable Prosthetic Titanium Rib - Synthes Spine Co.(r), West Chester, Pennsylvania, USA) as an option in spinal instrumentation without fusion in younger children with scoliosis, considering the complications inherent to spinal fusion in this age group. Methods: Sixteen (16) patients with scoliosis, regardless of etiology, with a mean age of 5.2 (3-8) years, were followed up by Spine Surgery Group at Hospital Getúlio Vargas, Recite-PE, and were submitted to surgical correction of the deformity using VEPTR, from April/2009 to July/2014. The survey was conducted through medical register review, and photographic and radiographic records, with the measurement of pre- and postoperative curves by the Cobb method. Results: The mean values of Cobb angle in the preoperative period, in the immediate postoperative period and after the last distraction were, respectively, 84.1° (112°-60°), 55.4° (92°-16°) and 64.4° (100°-16°), with an average initial correction of 28.7° (34.1%) and final correction of 19.7° (23.4%). The mean follow-up was 23.1 (0-61) months with an average distraction of 3.1 (0-8). The complication rate in this study was 62.5%. Conclusion: The VEPTR presented considerable correction rates of scoliosis curves in patients whose age contraindicate the spinal fusion methods. It is necessary to improve the technique and the implant itself in order to reduce complication rates, which can be considered relatively high, in addition to the conduction of more studies with longer follow-up to determine the actual efficacy of the implant and the maintenance of long-term correction.

scholarly journals Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study

2016 ◽  
Vol 25 (5) ◽  
pp. 610-619 ◽  
Author(s):  
Roberto Gazzeri ◽  
Raffaelino Roperto ◽  
Claudio Fiore
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Posterior Fixation ◽  
Spinal Diseases ◽  
Fixation Failure ◽  
Increased Risk ◽  
Screw Breakage ◽  
The Mean

OBJECTIVE Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. A variety of techniques have been used clinically to improve pedicle screw fixation in the presence of compromised bone. Pedicle screws may be augmented with cement, but this may lead to cement leakage and result in disastrous consequences. To avoid these complications, a multiaxial expandable pedicle screw has been developed. This was a prospective, single-center study designed to evaluate the clinical results of patients with osteoporosis with traumatic and degenerative spinal diseases treated with expandable pedicle screws. METHODS Thirty-three patients (mean age 61.4 years) with osteoporosis and traumatic or degenerative spinal diseases underwent spinal posterior fixation with expandable screws. Preoperative and postoperative visual analog scale (VAS) for pain and Oswestry Disability Index (ODI) questionnaire scores were obtained. The immediate postoperative screw position was measured and compared with the final position on lateral plain radiographs and axial CT scans at the 1- and 2-year follow-up examinations. RESULTS A total of 182 pedicle screws were used, including 174 expandable and 8 regular screws. The mean preoperative patient VAS score improved from 8.2 to 3.6 after surgery. The mean ODI score improved from 83.7% before surgery to 29.7% after the operation and to 36.1% at the final follow-up. No screw migration had occurred at the 1-year follow-up, but 1 screw breakage/migration was visualized on spinal radiography at the 2-year follow-up. CONCLUSIONS The results of this study show that the multiaxial expandable pedicle screw is a safe and practical technique for patients with osteoporosis and various spinal diseases and adds a valuable tool to the armamentarium of spinal instrumentation.

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