scholarly journals CLINICAL RESULTS AND REOPERATION RATES AFTER LONG ADULT DEFORMITY FUSIONS FROM THE SACRUM TO THE THORACOLUMBAR SPINE

2020 ◽  
Vol 31 (3) ◽  
pp. 135-140
Author(s):  
Abdul Fettah BUYUK ◽  
Amir MEHBOD
Keyword(s):  
Thoracolumbar Spine ◽  
Clinical Results ◽  
Adult Deformity ◽  
Reoperation Rates

Comparison of Long-Term (Five-Year) Reoperation Rates and Outcomes for Long Fusions to the Sacrum for Adult Deformity: Primary versus Revision Surgery

2013 ◽  
Vol 13 (9) ◽  
pp. S27
Author(s):  
Woojin Cho ◽  
David A. Essig ◽  
Michael J. Faloon ◽  
Gbolabo O. Sokunbi ◽  
Thomas Ross ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Adult Deformity ◽  
Reoperation Rates

VERTEBRAL BODY REPLACEMENT SYSTEMS WITH EXPANDABLE CAGES IN THE TREATMENT OF VARIOUS SPINAL PATHOLOGIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 537-545 ◽  
Author(s):  
Mark P. Arts ◽  
Wilco C. Peul
Keyword(s):  
Vertebral Body ◽  
Case Series ◽  
Clinical Results ◽  
Herniated Disc ◽  
Vertebral Body Replacement ◽  
Traumatic Fracture ◽  
Circumferential Fusion ◽  
Favorable Clinical Outcome ◽  
Reoperation Rates ◽  
Expandable Cages

ABSTRACT OBJECTIVE Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications. METHODS Sixty patients underwent single or multilevel corpectomy for degenerative stenosis (13 patients), herniated disc (7 patients), deformity (14 patients), traumatic fracture (3 patients), infection (1 patient), or tumor (22 patients). Six different expandable vertebral body systems were used in the cervical spine (41 patients), thoracic spine (15 patients), and lumbar spine (4 patients). All patients were evaluated clinically and radiographically. RESULTS Thirty-nine patients underwent single-level corpectomy, 18 patients underwent two-level corpectomy, and 3 patients underwent three-level corpectomy. Anterior reconstruction alone was performed in 30 patients; circumferential reconstruction was performed in 30 patients, 9 of whom underwent reconstruction through a posterior approach only. At the time of the final follow-up examination (mean, 9 mo), the Nurick grade improved significantly. Ninety-five percent of the patients maintained or improved their Frankel score and 67% had good clinical results. The regional angulation was corrected significantly (4.0 ± 9.0 degrees, P = 0.002), and the segment height increased significantly (3.5 ± 8.0 mm, P = 0.002). Bony fusion was achieved in 93% of the cases. Subsidence was documented in nearly half of the patients (1.4 ± 2.0 mm) and was reduced after circumferential fusion (0.9 ± 1.9 mm, P = 0.08). Eighteen patients (30%) had complications and 12 patients (20%) underwent revision surgery. CONCLUSION Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.

scholarly journals Comparison Between S2-Alar-Iliac Screw Fixation and Iliac Screw Fixation in Adult Deformity Surgery: Reoperation Rates and Spinopelvic Parameters

2017 ◽  
Vol 7 (7) ◽  
pp. 672-680 ◽  
Author(s):  
Wataru Ishida ◽  
Benjamin D. Elder ◽  
Christina Holmes ◽  
Sheng-Fu L. Lo ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Spinopelvic Parameters ◽  
Adult Deformity ◽  
Iliac Screw ◽  
Reoperation Rates

scholarly journals Protection of L1 nerve roots in vertebral osteotomy for severe rigid thoracolumbar spine deformity

2019 ◽  
Author(s):  
Hang Liao ◽  
Houguang Miao ◽  
Peng Xie ◽  
Yueyue Wang ◽  
Ningdao Li ◽  
...  
Keyword(s):  
Nerve Root ◽  
Bodily Pain ◽  
Thoracolumbar Spine ◽  
Operation Time ◽  
Clinical Results ◽  
Spine Deformity ◽  
Nerve Roots ◽  
Limb Weakness ◽  
Nerve Root Injury ◽  
Scoliosis Correction

Abstract Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to June 2017, 10 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO performed at T12 or L1, the kyphosis and scoliosis correction rates reached averages of 77.4 ± 8.5% and 76.6 ± 6.8%, intraoperative bleeding 1990 ± 1010 ml, operation time 7.12 ± 3.88 h. One year after surgery, the SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health from 60 ± 30, 47 ± 33, 44 ± 30, 32 ± 18, 50 ±30, 46 ± 29, 26 ± 40 and 52 ± 20 to 81 ± 16, 69 ± 19, 73 ± 11, 66 ± 21, 74 ± 16, 74 ± 24, 63 ± 37 and 76 ± 12, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by knee extension and hip flexion of lower limb weakness and inner thigh numbness, which further confirmed by electromyography. Conclusions : The parallel endplate osteotomy is simple, results in less bleeding, spinal cord and nerve root under direct vision and can effectively and safely correct severe rigid thoracolumbarspine deformity with better clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery. Key words: Thoracolumbar deformity, Nerve roots injury, L1 nerve roots, Parallel endplate osteotomy

TECHNIQUE AND CLINICAL RESULTS OF MINIMALLY INVASIVE RECONSTRUCTION AND STABILIZATION OF THE THORACIC AND THORACOLUMBAR SPINE WITH EXPANDABLE CAGES AND VENTROLATERAL PLATE FIXATION

Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. 798-809 ◽  
Author(s):  
Kai-Michael Scheufler
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Operative Time ◽  
Average Length ◽  
Plate Fixation ◽  
Thoracolumbar Spine ◽  
Clinical Results ◽  
Vertebral Body Replacement ◽  
Perioperative Morbidity

Abstract OBJECTIVE To evaluate the techniques of minimally invasive single- and multilevel corpectomy and reconstruction of the thoracic and thoracolumbar spine using expandable vertebral body replacement (VBR) cages and ventrolateral plate fixation (VPF) via anterolateral retropleural (ALRA) and combined thoracoabdominal approaches. METHODS 38 patients with spondylitis, traumatic or metastatic lesions of thoracic or thoracolumbar vertebrae T4 to L2 underwent spinal decompression and ventral column reconstruction with correction of spinal deformity by VBR and VPF via ALRA or a combined lateral extrapleural/extraperitoneal (extracoelomic) thoracolumbar approach (CLETA). Overall clinical and neurological outcome, operative time, blood loss, reduction of deformity, and postoperative pain were assessed during a mean follow-up period of 22.8 months. RESULTS VBR and VPF were carried out successfully without conversion to conventional approaches in all patients. Mean operative time (ALRA, 163 ± 33 min; CLETA, 175 ± 39 min), mean blood loss (ALRA, 280 ± 160 ml; CLETA, 420 ± 250 ml), average correction (19.3 degrees), loss of correction of sagittal deformity (0.9 degrees), and clinical outcome compare favorably to the results reported for open and endoscopic techniques. Postoperative pain levels (mean visual analog scale score at 24 h, 2.7 ± 0.9) and the incidence of postoperative pulmonary dysfunction (three out of 38 patients) were low. The average length of stay was 7.4 days. ALRA and CLETA obviate routine chest tube insertion, thus allowing for early postoperative ambulation (average, 1.1 d). CONCLUSION Minimally invasive VBR and VPF conducted via minimally invasive approaches (ALRA or CLETA) yields favorable clinical results at least equal to conventional open surgery, with significant reductions in perioperative morbidity and pain, expedited ambulation, and early discharge from the hospital.

DECISION MAKING IN ADULT DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A69-A77 ◽  
Author(s):  
Robert F. Heary ◽  
Sanjeev Kumar ◽  
Christopher M. Bono
Keyword(s):  
Decision Making ◽  
Sagittal Balance ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Optimal Timing ◽  
Curve Correction ◽  
Common Procedure ◽  
Adult Deformity ◽  
Frequent Use ◽  
Coronal Correction

ABSTRACT SPINAL DEFORMITY AFFECTS adults and adolescents in different ways. Adult deformity patients are skeletally mature and tend to have relatively fixed curves, whereas adolescent patients are skeletally immature with flexible curves. As a result, adult patients typically present with back pain and neurological concerns, whereas adolescents present with cosmetic complaints. The goals of surgery on the adult deformity patient are to treat pain and relieve neurological problems while maintaining or achieving three-dimensional balance. The absolute degree of coronal curve correction in an adult deformity patient is less important than maintaining good sagittal balance. Issues that must be addressed in the preoperative decision-making process include the approach to the surgery, the timing of the surgery, and the location of the end of the construct. Twenty years ago, anteroposterior surgery was the most common procedure used for adults with fixed curves; however, recent advances in technology and techniques have led to more frequent use of purely posterior approaches. The posterior approach allows for greater curve correction owing to two major advances in the surgical method: osteotomy techniques, which release fixed deformities, and pedicle screw instrumentation in the thoracolumbar spine, which achieves greater curve correction with fewer levels of fixation. The optimal timing of surgery and the levels to be treated remain open to debate. Each adult patient's treatment must be individualized to achieve the best coronal correction possible while maintaining sagittal balance to preserve the three-dimensional balance of the spine.

scholarly journals Adjustable Versus Nonadjustable Sutures in Strabismus Surgery—Who Benefits the Most?

2020 ◽  
Vol 9 (2) ◽  
pp. 292
Author(s):  
Maciej Gawęcki
Keyword(s):  
Comparative Studies ◽  
Controlled Trial ◽  
Clinical Results ◽  
Reoperation Rate ◽  
Strabismus Surgery ◽  
Target Angle ◽  
Adult Strabismus ◽  
Reoperation Rates ◽  
Significant Superiority ◽  
Restrictive Strabismus

Background: Adjustable sutures have been used in strabismus surgery for more than 40 years, but controversy remains regarding their application. This review sought to analyze studies comparing the efficacy of adjustable sutures (AS) and nonadjustable sutures (NAS) in the treatment of different ocular deviations. Materials and Methods: The PubMed literature database was searched using the keywords ‘adjustable sutures’ and ‘strabismus surgery’, yielding a total of 209 results. Only comparative studies were extracted, and the results were divided into three categories: Adult comitant strabismus, childhood comitant strabismus, and paretic/restrictive strabismus. Results: The search revealed eleven comparative studies on AS versus NAS in adult strabismus, including only one randomized controlled trial. Five of these studies analyzed just the postoperative success rate, three studies analyzed just the reoperation rate, two studies analyzed both the postoperative success and reoperation rates, and one study evaluated achievement of the postoperative target angle. Three of seven studies analyzing postoperative success reported the statically significant superiority of AS over NAS, while four of five studies analyzing reoperation rate indicated a significantly smaller percentage of reoperations with the use of AS. The study covering postoperative target angle as an outcome favored the AS technique. Separately, the search revealed three comparative studies on AS versus NAS in childhood strabismus, one of which reported a statistically significant advantage with AS. Only four comparative studies on AS versus NAS in paretic or restrictive strabismus were found; all showed a tendency for better results with the use of AS but not in a statistically significant fashion. Overall, out of 18 studies analyzed in this review, 17 suggested better clinical results followed the application of AS versus NAS; however, only a minority had statistically significant results. Conclusion: The analysis of available research failed to support AS as the preferable surgery technique over NAS in cases of simple and predictive strabismus. Further research is needed to more precisely determine the group of patients able to benefit the most from AS.

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