Biomaterials in spine surgery: the goal of enhancing spinal fusion

2014 ◽  
pp. 70-78
Author(s):  
Sabrina A Gonzalez-Blohm ◽  
James J Doulgeris ◽  
Frank D Vrionis
Keyword(s):  
Spinal Fusion ◽  
Spine Surgery

Complications related to instrumentation in spine surgery: a prospective analysis

2011 ◽  
Vol 31 (4) ◽  
pp. E10 ◽  
Author(s):  
Peter G. Campbell ◽  
Sanjay Yadla ◽  
Jennifer Malone ◽  
Mitchell G. Maltenfort ◽  
James S. Harrop ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Spine Surgery ◽  
Perioperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Benefit Analysis ◽  
History Of ◽  
Perioperative Complication ◽  
Definition Of ◽  
Risk Benefit Analysis

Object Prospective examination of perioperative complications in spine surgery is limited in the literature. The authors prospectively collected data on patients who underwent spinal fusion at a tertiary care center and evaluated the effect of spinal fusion and comorbidities on perioperative complications. Methods Between May and December 2008 data were collected prospectively in 248 patients admitted to the authors' institution for spine surgery. The 202 patients undergoing spine surgery with instrumentation were further analyzed in this report. Perioperative complications occurring within the initial 30 days after surgery were included. All adverse occurrences, whether directly related to surgery, were included in the analysis. Results Overall, 114 (56.4%) of 202 patients experienced at least one perioperative complication. Instrumented fusions were associated with more minor complications (p = 0.001) and more overall complications (0.0024). Furthermore, in the thoracic and lumbar spine, complications increased based on the number of levels fused. Advanced patient age and certain comorbidities such as diabetes, cardiac disease, or a history of malignancy were also associated with an increased incidence of complications. Conclusions Using a prospective methodology with a broad definition of complications, the authors report a significantly higher perioperative incidence of complications than previously indicated after spinal fusion procedures. Given the increased application of instrumentation, especially for degenerative disease, a better estimate of clinically relevant surgical complications could aid spine surgeons and patients in an individualized complication index to facilitate a more thorough risk-benefit analysis prior to surgery.

Minimally invasive retroperitoneal approach for lumbar corpectomy and anterior reconstruction

2000 ◽  
Vol 93 (1) ◽  
pp. 161-167 ◽  
Author(s):  
Manfred Mühlbauer ◽  
Wolfgang Pfisterer ◽  
Richard Eyb ◽  
Engelbert Knosp
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Spinal Fusion ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Content Type ◽  
Anterior Reconstruction ◽  
Fine Print ◽  
Lumbar Corpectomy

✓ The anterior decompressive procedure in which spinal fusion is performed is considered an effective treatment for thoracolumbar fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that lumbar corpectomy and anterior reconstruction can be performed via a minimally invasive retroperitoneal approach (MIRA) and therefore the surgical approach—related trauma can be reduced. The authors studied retrospectively the hospital records and radiological studies obtained in five patients (mean age 67.4 years, range 59–76 years) who underwent lumbar corpectomy and spinal fusion via an MIRA followed by posterior fixation. Four patients presented with osteoporotic compression fractures at L-2 and L-3, and one patient presented with metastatic disease in L-4 from prostate cancer. Neurological deficits due to cauda equina compression were demonstrated in all patients. The MIRA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. All patients improved clinically. A 1-year follow-up record is available for four patients and a 6-month follow-up record for the fifth patient; continuing clinical improvement has been observed in all. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the four patients for whom 1-year follow-up records were available. The MIRA allows the surgeon to perform anterior lumbar spine surgery via a less invasive approach. The efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery should be further investigated in a larger series.

Minimally invasive retroperitoneal approach for lumbar corpectomy and reconstruction

1999 ◽  
Vol 7 (6) ◽  
pp. E6 ◽  
Author(s):  
Manfred Mühlbauer ◽  
Wolfgang Pfisterer ◽  
Richard Eyb ◽  
Engelbert Knosp
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Spinal Fusion ◽  
Spine Surgery ◽  
Surgical Approach ◽  
Retroperitoneal Approach ◽  
Lumbar Spine Surgery ◽  
Spinal Reconstruction ◽  
Lumbar Corpectomy

Anterior decompressive surgery with spinal fusion is considered an effective treatment for thoracolumbar fractures and tumors. However, it is also known to be associated with considerable surgical approach–related trauma. The purpose of this study was to show that lumbar corpectomy and spinal reconstruction can be performed via a minimally invasive retroperitoneal (MIR) approach and therefore, the surgical approach–related trauma can be reduced. The hospital records and radiological studies obtained in five patients (mean age 67.4 years, range 59-76 years) who underwent lumbar corpectomy and spinal fusion via an MIR approach were studied retrospectively. Four patients presented with osteoporotic compression fractures at L-2 and L-3 and one patient with metastatic disease at L-4 from prostate cancer. In all patients neurological deficits due to cauda equina compression were demonstrated. The MIR approach provided excellent exposure to facilitate complete spinal decompression and reconstruction in all patients, as verified on follow-up x-ray studies. All patients improved clinically. A 1-year follow-up record, available for four patients, showed evidence of continuing clinical improvement and, radiographically, a solid fusion or a stable compound union and anatomically correct reconstruction. The MIR approach allows anterior lumbar spine surgery to be performed less invasively. The efficacy and safety of this technique compared with the conventional retroperitoneal approach to lumbar spine surgery should be further investigated in a larger series.

scholarly journals Intradural spine surgery may not carry an increased risk of shunt revision compared with extradural spine surgery in pediatric patients with myelomeningocele

2018 ◽  
Vol 21 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Elizabeth N. Kuhn ◽  
Betsy Hopson ◽  
Michael J. Conklin ◽  
Jeffrey P. Blount
Keyword(s):  
Spinal Fusion ◽  
Spine Surgery ◽  
Pediatric Patients ◽  
Tethered Cord ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Rank Test ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Significant Difference

OBJECTIVEPatients with myelomeningocele are often affected by scoliosis and tethered cord syndrome, and frequently require spine surgery. Intradural spine surgeries may carry an inherently higher risk of inducing shunt malfunction due to entry into the subarachnoid space. In this study, the authors sought to compare rates of shunt malfunction after intradural and extradural spine surgeries among pediatric patients with myelomeningocele.METHODSThe authors reviewed records of the National Spina Bifida Program Registry for Children’s Hospital of Alabama. The Exago reporting function was used to identify patients who had received at least one of the following procedures: shunt revision, tethered cord release (TCR), or spinal fusion for deformity. The registry records were reviewed for all identified patients to determine if a shunt revision was performed within the 1st year after TCR or spinal fusion.RESULTSFinal analyses included 117 patients, of whom 39 underwent spinal fusion and 78 underwent TCR. Among patients who underwent spinal fusion, shunt revision was performed within 30 days in 2 patients (5.1%), within 60 days in 2 (5.1%), within 90 days in 4 (10.3%), and within 1 year in 5 (12.8%). Among patients who underwent TCR, shunt revision was performed within 30 days in 7 patients (9.0%), within 60 days in 10 (12.8%), within 90 days in 11 (14.1%), and within 1 year in 17 (21.8%). Using the log-rank test, there was no significant difference in Kaplan-Meier curves between intradural and extradural groups (p = 0.59).CONCLUSIONSIn a review of single-institution registry data, the authors found no statistically significant difference in the risk of shunt malfunction after intradural and extradural spine surgeries.

scholarly journals Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

2019 ◽  
Vol 16 (2) ◽  
pp. 155-161
Author(s):  
Michael H. McCarthy ◽  
Joseph A. Weiner ◽  
Alpesh A. Patel
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Spine Surgery ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery

Rate of instrumentation changes on postoperative and follow-up radiographs after primary complex spinal fusion (five or more levels) for adult deformity correction

2019 ◽  
Vol 30 (3) ◽  
pp. 376-381
Author(s):  
Aladine A. Elsamadicy ◽  
David T. Lubkin ◽  
Amanda R. Sergesketter ◽  
Syed M. Adil ◽  
Lefko T. Charalambous ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Spine Surgery ◽  
Deformity Correction ◽  
The United States ◽  
Spine Deformity ◽  
Complication Rates ◽  
Old Patients ◽  
Primary Complex ◽  
The Mean

OBJECTIVEIn the United States, healthcare expenditures have been soaring at a concerning rate. There has been an excessive use of postoperative radiographs after spine surgery and this has been a target for hospitals to reduce unnecessary costs. However, there are only limited data identifying the rate of instrumentation changes on radiographs after complex spine surgery involving ≥ 5-level fusions.METHODSThe medical records of 136 adult (≥ 18 years old) patients with spine deformity undergoing elective, primary complex spinal fusion (≥ 5 levels) for deformity correction at a major academic institution between 2010 and 2015 were reviewed. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient. The authors reviewed the first 5 subsequent postoperative and follow-up radiographs, and determined whether revision of surgery was performed within 5 years postoperatively. The primary outcome investigated in this study was the rate of hardware changes on follow-up radiographs.RESULTSThe majority of patients were female, with a mean age of 53.8 ± 20.0 years and a body mass index of 27.3 ± 6.2 kg/m2 (parametric data are expressed as the mean ± SD). The median number of fusion levels was 9 (interquartile range 7–13), with a mean length of surgery of 327.8 ± 124.7 minutes and an estimated blood loss of 1312.1 ± 1269.2 ml. The mean length of hospital stay was 6.6 ± 3.9 days, with a 30-day readmission rate of 14.0%. Postoperative and follow-up change in stability on radiographs (days from operation) included: image 1 (4.6 ± 9.3 days) 0.0%; image 2 (51.7 ± 49.9 days) 3.0%; image 3 (142.1 ± 179.8 days) 5.6%; image 4 (277.3 ± 272.5 days) 11.3%; and image 5 (463.1 ± 525.9 days) 15.7%. The 3rd year after surgery had the highest rate of hardware revision (5.55%), followed by the 2nd year (4.68%), and the 1st year (4.54%).CONCLUSIONSThis study suggests that the rate of instrumentation changes on radiographs increases over time, with no changes occurring at the first postoperative image. In an era of cost-conscious healthcare, fewer orders for early radiographs after complex spinal fusions (≥ 5 levels) may not impact patient care and can reduce the overall use of healthcare resources.

Chronic bone abscess as an unusual cause of dysphagia

1991 ◽  
Vol 105 (12) ◽  
pp. 1084-1085 ◽  
Author(s):  
Art A. P. Connolly ◽  
John Waldron ◽  
Nicolas Stafford ◽  
Rolfe Birch
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Spine Surgery ◽  
Unusual Case ◽  
Chronic Infections ◽  
Anterior Spinal Fusion ◽  
Cervical Spine Surgery

AbstractChronic infections following cervical spine surgery are rare. Here we describe an unusual case presenting five years after anterior spinal fusion.

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