scholarly journals Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

2017 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Akshay Jain ◽  
R.K. Jain ◽  
Vivek Kiyawat
Keyword(s):  
Back Pain ◽  
Pedicle Screws ◽  
Direct Access ◽  
Instrumented Fusion ◽  
Loss Of Correction ◽  
Vas Score ◽  
Transpedicular Approach ◽  
Thoracolumbar Region ◽  
Radiological Healing

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>We evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.</p></sec><sec><title>Overview of Literature</title><p>For surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.</p></sec><sec><title>Methods</title><p>A total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.</p></sec><sec><title>Results</title><p>Mean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.</p></sec><sec><title>Conclusions</title><p>Transpedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.</p></sec>

scholarly journals Active Apex Correction With Guided Growth Technique for Controlling Spinal Deformity in Growing Children: A Modified SHILLA Technique

2019 ◽  
Vol 10 (4) ◽  
pp. 438-442 ◽  
Author(s):  
Aakash Agarwal ◽  
Loai Aker ◽  
Alaaeldin Azmi Ahmad
Keyword(s):  
Pedicle Screws ◽  
Convex Side ◽  
Modified Technique ◽  
Guided Growth ◽  
Growth Technique ◽  
Loss Of Correction ◽  
And Control ◽  
Relative Change

Study Design: A retrospective study. Objective: To determine if active remodulation in the apex of the curve is possible in scoliosis and kyphoscoliosis patients, using a modified SHILLA; active apex correction (APC) technique for guided growth. Method: Twenty patients with either scoliosis or kyphoscoliosis underwent a modified SHILLA approach, where instead of apical fusion, APC was applied. In this modified technique, the most wedged vertebra was selected followed by insertion of pedicle screws in the convex side of the vertebrae above and below the wedged one. The convex and concave heights of the wedged and control vertebrae were recorded at the time of the surgery and at follow-up duration, both using computed tomography. Results: The wedged vertebra demonstrated in average a 17% ( P = .00014) increase in the proportion of concave to convex heights ratio, whereas the control vertebra did not show any relative change in the wedged vertebra heights at the follow-ups. Conclusion: APC, instead of apical fusion in SHILLA remodulates the apex vertebra, which may in turn help mitigate loss of correction on long term due to crankshafting and adding-on.

scholarly journals Modified mini-open SRS-Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation in post-traumatic thoracolumbar kyphosis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Wubo Liu ◽  
Yiwei Zhao ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Xinyu Liu
Keyword(s):  
Back Pain ◽  
Pedicle Screws ◽  
Neurological Dysfunction ◽  
Control Group ◽  
Thoracolumbar Kyphosis ◽  
Estimated Blood Loss ◽  
Group A ◽  
Post Traumatic ◽  
Group B

Abstract Background We aimed to analyze the clinical results of Schwab grade 4 osteotomy combined with percutaneous pedicle screws (PPS) fixation for treatment of post-traumatic thoracolumbar kyphosis (PTK). Methods Thirty four patients with PTK (group A) were included in our study. The average age was 54.9 ± 3.3 years. All patients had severe back pain with 8.6 ± 1.3 VAS scores. The affected level was T12 in 16 patients and L1 in 18 patients. The average preoperative regional kyphosis angle (RKA) was 30.7 ± 6.00. Three patients had neurological dysfunction with ASIA grade D. All patients underwent Schwab grade 4 osteotomy combined with PPS fixation. The control group (Group B) were 26 PTK patients treated with Schwab grade 4 osteotomy and open pedicle screws fixation in our institution. Results Operation time in groups A and B was 280 ± 50 min and 210 ± 30 min, respectively (P < 0.05). Estimated blood loss in groups A and B was 310 ± 70 ml and 630 ± 40 ml, respectively (P < 0.05). No cerebral spinal fluid leakage, segmental nerve function damage, and other complications observed during and after the operations in both groups. RKA, SVA, and LL improved significantly after surgery in both groups (P < 0.05). The average correction rate in groups A and B was 64.5 and 66.3% (P > 0.05). CT showed that the misplacement rate in groups A and B was 5.5 and 6.6% (P > 0.05). The average follow-up in groups A and B was 25.2 ± 7.6 months and 30.6 ± 2.7 months. No fracture and other complications were observed in both groups. Solid bone fusion was showed in all cases at 6 months follow-up. In groups A and B, all patients with preoperative neurological dysfunction recovered to ASIA grade E at the last follow-up. The VAS score of back pain improved significantly from 8.6 ± 1.3 to 1.6 ± 1.0 at the last follow-up in group A (P < 0.05), while it improved significantly from 8.3 ± 1.2 to 3.0 ± 1.1 at the last follow-up in group B (P < 0.05). VAS of back pain was better in group A than that in group B. Conclusion Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation is a minimally invasive, safe and effective method for PTK treatment.

Treatment of Vertebral Hemangiomas With Absolute Alcohol (Ethanol) Embolization, Cord Decompression, and Single Level Instrumentation: A Pilot Study

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Pankaj. Singh ◽  
Nalin K. Mishra ◽  
Hari Har. Dash ◽  
Rajender K. Thyalling ◽  
Bhawani S. Sharma ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Pedicle Screws ◽  
Cord Compression ◽  
Absolute Alcohol ◽  
Alcohol Injection ◽  
Instrumented Fusion ◽  
Single Level ◽  
Vertebral Hemangiomas ◽  
Ethanol Embolization

Abstract BACKGROUND: Vertebral hemangiomas (VH) are the most common lesions of the vertebral column. OBJECT: To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy. METHODS: This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS: Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years. CONCLUSION: This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.

scholarly journals EVALUATE THE PHYSICALACTIVITY (MOBILITY-INDOOR,OUTDOOR) AND VAS SCORE OF TRANSPEDICULAR DECOMPRESSION AND INSTRUMENTED FUSION IN PATIENTS WITH THORACIC AND THORACOLUMBAR FRACTURE

2020 ◽  
pp. 40-41
Author(s):  
Sharad Panwar ◽  
Kk Pandey
Keyword(s):  
Physical Activity ◽  
Functional Outcome ◽  
Daily Life ◽  
Thoracolumbar Fracture ◽  
Instrumented Fusion ◽  
Vas Score ◽  
Walking Aids ◽  
Score Result ◽  
Excellent Improvement

AIMS & OBJECTIVES Evaluate the Physical activity (mobility-indoor,outdoor) and VAS score of Transpedicular decompression and instrumented fusion in patients with thoracic and thoracolumbar fracture . Method We include 30 patients and score was recorded from admission, preoperatively, immediate post operatively at the time of discharge and follow up period ( 1 month, 6 month, 1 year ) and evaluate the patients Physical activity (mobility-indoor,outdoor) and VAS score. Result In this study we found that there is gradual and excellent improvement in functional outcome in patients daily life . with the help of walking aids , wheelchair/ physiotherapy patients improve their routine lifestyle after undergo transpedicul decompression and instrumented fusion. In this study we found that there is gradual and excellent improvement in functional outcome in patients daily life .Mean mobility-indoor,outdoor is 1.4 in post op, 8.9 in 3 month, 14.23 at 6 month , 19.36 at 1 year and VAS score at pre op , post op , 3 month 6 month and 1 year is respectively 8 , 7.75 , 4.06 ,1.9 , and 1.23 .

scholarly journals Back pain outcomes after minimally invasive anterior lumbar interbody fusion: a systematic review

2020 ◽  
Vol 49 (3) ◽  
pp. E3
Author(s):  
Alvin Y. Chan ◽  
Brian V. Lien ◽  
Elliot H. Choi ◽  
Andrew K. Chan ◽  
George Hanna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Vas Score ◽  
Pain Outcomes ◽  
The Mean

OBJECTIVEMinimally invasive anterior lumbar interbody fusion surgery (MIS ALIF) is a technique that restores disc height and lumbar lordosis through a smaller exposure and less soft-tissue trauma compared to open approaches. The mini-open and laparoscopic assistance techniques are two main forms of MIS ALIF. The authors conducted a systematic review that sought to critically summarize the literature on back pain following MIS ALIF.METHODSIn March 2020, the authors searched the PubMed, Web of Science, and Cochrane Library databases for studies describing back pain visual analog scale (VAS) outcomes after MIS ALIF. The following exclusion criteria were applied to studies evaluated in full text: 1) the study included fewer than 20 patients, 2) the mean follow-up duration was shorter than 12 months, 3) the study did not report back pain VAS score as an outcome measure, and 4) MIS ALIF was not studied specifically. The methodology for the included studies were evaluated for potential biases and assigned a level of evidence.RESULTSThere were a total of 552 patients included from 13 studies. The most common biases were selection and interviewer bias. The majority of studies were retrospective. The mean sample size was 42.3 patients. The mean follow-up duration was approximately 41.8 months. The mean postoperative VAS reduction was 5.1 points. The mean VAS reduction for standalone grafts was 5.9 points, and 5.0 points for those augmented with posterior fixation. The most common complications included bladder or urinary dysfunction, infection, and hardware-related complications.CONCLUSIONSThis was a systematic review of back pain outcomes following MIS ALIF. Back pain VAS score was reduced postoperatively across all studies. The complication rates were low overall. MIS ALIF is safe and effective at reducing back pain in appropriate patient populations.

scholarly journals The feasibility and safety of using sublaminar polyester bands in hybrid spinal constructs in children and transitional adults for neuromuscular scoliosis

2015 ◽  
Vol 15 (3) ◽  
pp. 328-337 ◽  
Author(s):  
Sohum K. Desai ◽  
Christina Sayama ◽  
Daniel Vener ◽  
Alison Brayton ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Neuromuscular Scoliosis ◽  
Bone Morphogenetic Protein 2 ◽  
Instrumented Fusion ◽  
Radiographic Outcomes ◽  
Estimated Blood Loss ◽  
Posterior Instrumented Fusion

OBJECT The authors have previously reported on their early experience with sublaminar polyester bands in spine surgery. In this paper, the authors describe the use of sublaminar polyester bands in long-segment posterior instrumented spinal fusions from the upper thoracic spine to the ilium in 21 children and transitional adults with progressive neuromuscular scoliosis. Transitional adults were patients older than 18 years of age with a spinal disorder of pediatric onset, such as spina bifida. This dedicated study represents the first reported use of polyester bands in spine surgery for neuromuscular scoliosis in this patient population in the US. METHODS The authors retrospectively reviewed the demographics and procedural data of patients who underwent posterior instrumented fusion using sublaminar polyester bands for neuromuscular scoliosis. RESULTS Twenty-one pediatric and adult transitional patients, ranging in age from 10 to 20 years (mean 14 years), underwent posterior instrumented fusion for progressive neuromuscular scoliosis. The average coronal Cobb angle measured 66° before surgery (range 37°–125°). Immediately after surgery, the mean coronal Cobb angle was 40° (range 13°–85°). At last follow-up, the average coronal Cobb angle was maintained at 42° (range 5°–112°). Regarding sagittal parameters, thoracic kyphosis was restored by 8%, and lumbar lordosis improved by 20% after surgery. Mean follow-up duration was 17 months (range 2–54 months). One patient with an aborted procedure due to loss of intraoperative evoked potentials was excluded from the analysis of radiographic outcomes. Mean surgical time was 7 hours 43 minutes (range 3 hours 59 minutes to 10 hours 23 minutes). All patients received either a 12- or 24-mg dose of recombinant human bone morphogenetic protein–2. Average estimated blood loss was 976 ml (range 300–2700 ml). Complications directly related to the use of sublaminar instrumentation included transient proprioceptive deficit (1 patient) and prolonged paraparesis (1 patient). Other complications noted in this series included disengagement of the rod from an iliac screw (1 patient), proximal junctional kyphosis (1 patient), noninfected wound drainage (2 patients), and perioperative death (1 patient). The lessons learned from these complications are discussed. CONCLUSIONS Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires have been incorporated into posterior spinal constructs and widely reported and used in the thoracic and lumbar spines and sacrum with varying success. This report demonstrates the satisfactory radiological outcomes of hybrid posterior spinal constructs in pediatric and adult neuromuscular scoliosis that include sublaminar polyester bands that promise the technical ease of passing sublaminar instrumentation with the immediate biomechanical rigidity of pedicle screws and hooks. However, the high neurological complication rate associated with this technique (2/21, or 10%) tempers the acceptable radiographic outcomes.

scholarly journals The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis

2015 ◽  
Vol 23 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Sho Dohzono ◽  
Hiromitsu Toyoda ◽  
Tomiya Matsumoto ◽  
Akinobu Suzuki ◽  
Hidetomi Terai ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Plumb Line ◽  
Leg Pain ◽  
Low Back ◽  
Vas Score ◽  
Canal Stenosis ◽  
Lumbar Spinal

OBJECT More information about the association between preoperative anterior translation of the C-7 plumb line and clinical outcomes after decompression surgery in patients with lumbar spinal canal stenosis (LSS) would help resolve problems for patients with sagittal imbalance. The authors evaluated whether preoperative sagittal alignment of the spine affects low-back pain and clinical outcomes after microendoscopic laminotomy. METHODS This study was a retrospective review of prospectively collected surgical data. The study comprised 88 patients with LSS (47 men and 41 women) who ranged in age from 39 to 86 years (mean age 68.7 years). All patients had undergone microendoscopic laminotomy at Osaka City University Graduate School of Medicine from May 2008 through October 2012. The minimum duration of clinical and radiological follow-up was 6 months. All patients were evaluated by Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness before and after surgery. The distance between the C-7 plumb line and the posterior corner of the sacrum (sagittal vertical axis [SVA]) was measured on lateral standing radiographs of the entire spine obtained before surgery. Radiological factors and clinical outcomes were compared between patients with a preoperative SVA ≥ 50 mm (forward-bending trunk [F] group) and patients with a preoperative SVA < 50 mm (control [C] group). A total of 35 patients were allocated to the F group (19 male and 16 female) and 53 to the C group (28 male and 25 female). RESULTS The mean SVA was 81.0 mm for patients in the F group and 22.0 mm for those in the C group. At final follow-up evaluation, no significant differences between the groups were found for the JOA score improvement ratio (73.3% vs 77.1%) or the VAS score for leg numbness (23.6 vs 24.0 mm); the VAS score for low-back pain was significantly higher for those in the F group (21.1 mm) than for those in the C group (11.0 mm); and the VAS score for leg pain tended to be higher for those in the F group (18.9 ± 29.1 mm) than for those in the C group (9.4 ± 16.0 mm). CONCLUSIONS Preoperative alignment of the spine in the sagittal plane did not affect JOA scores after microendoscopic laminotomy in patients with LSS. However, low-back pain was worse for patients with preoperative anterior translation of the C-7 plumb line than for those without.

scholarly journals Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hyeun Sung Kim ◽  
Nitin Adsul ◽  
Farid Yudoyono ◽  
Byapak Paudel ◽  
Ki Joon Kim ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Laser Ablation ◽  
Chronic Low Back Pain ◽  
Modic Changes ◽  
Type I ◽  
Low Back ◽  
Vas Score ◽  
The Mean

Background. Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods. Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnab’s criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results. The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P<0.01). As per Macnab’s criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion. The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.

scholarly journals Decompression alone versus decompression and instrumented fusion for the treatment of isthmic spondylolisthesis: a randomized controlled trial

2021 ◽  
pp. 1-11
Author(s):  
Kayoumars Azizpour ◽  
Pieter Schutte ◽  
Mark P. Arts ◽  
Willem Pondaag ◽  
Gerrit J. Bouma ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Technique ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Neurogenic Claudication ◽  
Low Grade ◽  
Secondary Outcome Measure ◽  
Isthmic Spondylolisthesis ◽  
Instrumented Fusion

OBJECTIVE The most advocated surgical technique to treat symptoms of isthmic spondylolisthesis is decompression with instrumented fusion. A less-invasive classical approach has also been reported, which consists of decompression only. In this study the authors compared the clinical outcomes of decompression only with those of decompression with instrumented fusion in patients with isthmic spondylolisthesis. METHODS Eighty-four patients with lumbar radiculopathy or neurogenic claudication secondary to low-grade isthmic spondylolisthesis were randomly assigned to decompression only (n = 43) or decompression with instrumented fusion (n = 41). Primary outcome parameters were scores on the Roland Disability Questionnaire (RDQ), separate visual analog scales (VASs) for back pain and leg pain, and patient report of perceived recovery at 12-week and 2-year follow-ups. The proportion of reoperations was scored as a secondary outcome measure. Repeated measures ANOVA according to the intention-to-treat principle was performed. RESULTS Decompression alone did not show superiority in terms of disability scores at 12-week follow-up (p = 0.32, 95% CI −4.02 to 1.34), nor in any other outcome measure. At 2-year follow-up, RDQ disability scores improved more in the fusion group (10.3, 95% CI 3.9–8.2, vs 6.0, 95% CI 8.2–12.4; p = 0.006, 95% CI −7.3 to −1.3). Likewise, back pain decreased more in the fusion group (difference: −18.3 mm, CI −32.1 to −4.4, p = 0.01) on a 100-mm VAS scale, and a higher proportion of patients perceived recovery as showing “good results” (44% vs 74%, p = 0.01). Cumulative probabilities for reoperation were 47% in the decompression and 13% in the fusion group (p < 0.001) at the 2-year follow-up. CONCLUSIONS In patients with isthmic spondylolisthesis, decompression with instrumented fusion resulted in comparable short-term results, significantly better long-term outcomes, and fewer reoperations than decompression alone. Decompression with instrumented fusion is a superior surgical technique that should in general be offered as a first treatment option for isthmic spondylolisthesis, but not for degenerative spondylolisthesis, which has a different etiology.

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