Long-term Quality of Life after Fusion of the Ventral Thoracic and Lumbar Spine

Background Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. Material and Methods Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. Results Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. Conclusions Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation.

Anterior Cervical Corpectomy with Fusion versus Anterior Hybrid Fusion Surgery for Patients with Severe Ossification of the Posterior Longitudinal Ligament Involving Three or More Levels: A Retrospective Comparative Study

Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.

Integration of Umbilical Cord Mesenchymal Stem Cell Application in Hydroxyapatite-Based Scaffolds in the Treatment of Vertebral Bone Defect due to Spondylitis Tuberculosis: A Translational Study

Background. Vertebral bone defect represents one of the most commonly found skeletal problems in the spine. Progressive increase of vertebral involvement of skeletal tuberculosis (TB) is reported as the main cause, especially in developed countries. Conventional spinal fusion using bone graft has been associated with donor-site morbidity and complications. We reported the utilization of umbilical cord mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite (HA) based scaffolds in treating vertebral bone defect due to spondylitis tuberculosis. Materials and Methods. Three patients with tuberculous spondylitis in the thoracic, thoracolumbar, or lumbar region with vertebral body collapse of more than 50 percent were included. The patient underwent a 2-stage surgical procedure, consisting of debridement, decompression, and posterior stabilization in the first stage followed by anterior fusion using the lumbotomy approach at the second stage. Twenty million UC-MSCs combined with HA granules in 2 cc of saline were transplanted to fill the vertebral bone defect. Postoperative alkaline phosphatase level, quality of life, and radiological healing were evaluated at one-month, three-month, and six-month follow-up. Results. The initial mean ALP level at one-month follow-up was 48.33 ± 8.50 U / L . This value increased at the three-month follow-up but decreased at the six-month follow-up time, 97 ± 8.19 U / L and 90.33 ± 4.16 U / L , respectively. Bone formation of 50-75% of the defect site with minimal fracture line was found. Increased bone formation comprising 75-100% of the total bone area was reported six months postoperation. A total score of the SF-36 questionnaire showed better progression in all 8 domains during the follow-up with the mean total score at six months of 2912.5 ± 116.67 from all patients. Conclusion. Umbilical cord mesenchymal stem cells combined with hydroxyapatite-based scaffold utilization represent a prospective alternative therapy for bone formation and regeneration of vertebral bone defect due to spondylitis tuberculosis. Further clinical investigations are needed to evaluate this new alternative.

Pediatric spinal deformity correction in children with cerebral palsy: natural history and correction techniques

Introduction Spinal deformity is one of major orthopaedic manifestations of cerebral palsy (CP). Despite the prevalence of the nosologic condition there is a deficiency in the availability of criteria for screening and management of the spinal pathology in CP patients, difficulties in interdisciplinary logistics, lack of registry and restraints in the continuity of the rehabilitation system. The purpose of the work was to focus the attention of mainstream audience of dedicated experts on the aspects of the course and correction techniques of spinal deformities in CP patients. Evidence level 5 (UK Oxford, version 2011). Results The type of spinal deformity depends on the functional level classified with the GMFCS. Vertebral evaluation included identification of the leading component of the deformity, apex location, mobility, trunk balance, chest deformity, type of pelvic obliquity, the way contractures and dislocation of the femoral heads affected the lumbar spine mobility. The goal of spinal deformity correction in CP patients is to maintain or improve the functionality of the patients, improve the quality of life for the patient and the family. The use of transpedicular multi-support fixation systems and bone allografts can be recommended for bone fusion in the patients. Spinal fixation can be extended from the upper thoracic vertebrae down to the pelvis. Dynamic fixation systems, multilevel or multi-rod fixation can be an option depending on the age, extent of the maturity of the axial skeleton and size of the curve. Conclusion The severity of manifestations of spinal deformity increases in CP patients with greater level of global motor functions and does not depend on the skeletal maturity. Conservative treatment is ineffective at a long term. Correction and instrumentation transpedicular fixation allows for threedimensional correction without the need for anterior fusion. Surgical treatment significantly improves body balance, functional level and quality of life.

Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

Background and Objectives: Stabilization of the spine by cage implantation or autologous pelvic bone graft are surgical methods for the treatment of traumatic spine fractures. These methods serve to stably re-adjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. They both involve ventral interventions using interbody fusion to replace the intervertebral disc space between the vertebral bodies either by cages or autologous pelvic bone grafts. We examined which of these methods serves the patients better in terms of bone fusion and the long-term clinical outcome. Materials and Methods: Forty-six patients with traumatic fractures (12 cages; mean age: 54.08/34 pelvic bone grafts; mean age: 42.18) who received an anterior fusion in the thoracic or lumbar spine were included in the study. Postoperative X-ray images were evaluated, and fusion of the stabilized segment was inspected by two experienced spine surgeons. The time to discharge from hospital and gender differences were evaluated. Results: There was a significant difference of the bone fusion rate of patients with autologous pelvic bone grafts in favor of cage implantation (p = 0.0216). Also, the stationary phase of patients who received cage implantations was clearly shorter (17.50 days vs. 23.85 days; p = 0.0089). In addition, we observed a significant gender difference with respect to the bony fusion rate in favor of females treated with cage implantations (p < 0.0001). Conclusions: Cage implantations after spinal fractures result in better bony fusion rates as compared to autologous pelvic bone grafts and a shorter stay of the patients in the hospital. Thus, we conclude that cage implantations rather than autologous pelvic bone grafts should be the preferred surgical treatment for stabilizing the spine after fracture.

Sequential traumatic cervical fractures after paragliding accidents – A case report and literature review

Background: Sports related cervical spine trauma may range from minor injuries to severe life-threatening fractures with spinal cord injuries as following paragliding accidents. Case Description: A 52-year-old male sustained C4-C5 and C6-C7 fracture-dislocations (American Spinal Injury Association-D) attributed to a paragliding accident. He underwent a C5 corpectomy with C4-C6 anterior fusion. Three years later, he again sustained a paragliding accident, now resulting in a C6-C7 fracture-dislocation that required a C6-C7 anterior discectomy fusion. However, when this latter fusion “failed” 1 month later, he subsequently required a 360° fusion performed as a two-stage procedure. Further, 2 years later, he was involved in a motor vehicle accident resulting in an odontoid fracture. Conclusion: Unstable spinal fractures require surgical fixation to prevent neurological injury. Long cervical fusions create lever arms that increase the stress to adjacent levels, rendering them prone to future injury.

Single-Position Surgery: Prone Lateral Lumbar Interbody Fusion: 2-Dimensional Operative Video

Lateral lumbar interbody fusion (LLIF) is a widely used technique for anterior fusion. However, posterior decompression or instrumentation often requires repositioning the patient, which increases operative time. This video describes the prone LLIF as a modification of the standard surgical technique. The prone LLIF facilitates simultaneous decompression and fusion, which avoids the need for repositioning the patient, increasing operative efficiency. Positioning, fluoroscopic considerations, and operative nuances involved in performing the LLIF in the prone position are described, and an illustrative case is presented. The patient provided informed consent for the procedure and videography. LLIF in the prone position can decrease operative time and increase operative efficiency. The prone position is a viable alternative to the conventional lateral decubitus position. Video used with permission from Barrow Neurological Institute, Phoenix, Arizona.

A Rare Case of Contiguous Three-level Lumbar Burst Fractures-treated with Combined Posterior Stabilization and Anterior Fusion

Introduction: Burst fractures occur frequently in high energy trauma and are commonly associated with falls from height and road traffic accidents. While multiple burst fractures are not uncommon in thoracic spine, three or more contiguous level burst fractures are a relative rarity especially, in lumbar spine. The treatment of multilevel burst fractures must be individualized, and each fracture should be treated according to its inherent stability. To the best of our knowledge, this is the only case of such injury reported in English literature. Case Report: A 17-year-old girl who sustained contiguous three-level lumbar burst fractures with neurological compromise following alleged history of fall from height. Radiographs/computed tomography scan revealed burst fractures of L2, L3, and L4 vertebrae with retropulsion of bony fragments at all the levels. Patient underwent minimally invasive posterior stabilization and anterior Hemi-corpectomy of L2, L4, and fusion. The patient recovered completely from neurological deficits by the end of 6 months. Conclusion: Multiple contiguous burst fractures in the lumbar spine are a rare entity. To the best of our knowledge, this is the only case of such injury reported in English literature. The treatment requires a thorough assessment of the fracture pattern and often requires a combination of surgical approaches. Each fracture merits treatment based on individual characteristics of fracture patterns and the amount of canal compromise at each level. Keywords: Lumbar, burst fracture, multiple, contiguous.

Anterior Fusion using a Vascularized Fibular Graft for Cervical Kyphosis Associated with Neurofibromatosis Type 1: A Report of Two Cases with Long-term Follow-up

Introduction: Vascularized fibular grafts (VFG) in the cervicothoracic spine have been used for patients with progressive neurofibromatosis (NF) type-1-related kyphosis, but the long-term outcomes of VFG with NF-1 are not well described. We describe the long-term follow-up of two cases of cervical kyphosis related to NF-1 treated with VFG in the cervical spine. Case Report: Case 1 was that of a 33-year-old man with a large neurofibroma at the back of his neck and an arteriovenous malformation at C2–7. The neurofibroma was resected by durotomy and intradural neurofibromas were extirpated through O-C6 laminectomy. Anterior fusion with VFG was performed 6 months later, and bone union was confirmed after 4 months. Cervical alignment was maintained with 50° kyphosis 15 years after the operation. The man suffered a subarachnoid hemorrhage 22 years after the operation. Case 2 was a 23-year-old woman with diastematomyelia at C6–T1 who was treated by anterior fusion with VFG at C4–T1. The diastematomyelia septum was resected through a C4–T1 laminectomy with simultaneous posterolateral fusion at C3–T2. Cervical alignment was maintained with 50° kyphosis 18 years later. The left vertebral artery ruptured and was embolized 10 years after the operation. Conclusion: Anterior fusion with VFG can achieve good bone union and maintains long-term alignment. However, it is important to watch for vascular events related to NF-1. Keywords: Vascularized fibular graft, cervical kyphosis, neurofibromatosis type 1.