[Surgical treatment of de-novo scoliosis].

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[Surgical treatment of de-novo scoliosis].

Orthopade. 2016 Sep;45(9):744-54

Authors: Putzier M, Pumberger M, Halm H, Zahn RK, Franke J

Abstract
BACKGROUND: De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient’s symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient’s symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy.
TREATMENT: Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success.
CONCLUSION: All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.

PMID: 27514825 [PubMed – indexed for MEDLINE]

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Analysis of Associating Factors With C2-7 Sagittal Vertical Axis After Two-level Anterior Cervical Fusion: Comparison Between Plate Augmentation and Stand-alone Cages.

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Analysis of Associating Factors With C2-7 Sagittal Vertical Axis After Two-level Anterior Cervical Fusion: Comparison Between Plate Augmentation and Stand-alone Cages.

Spine (Phila Pa 1976). 2017 Mar;42(5):318-325

Authors: Kwon WK, Kim PS, Ahn SY, Song JY, Kim JH, Park YK, Kwon TH, Moon HJ

Abstract
STUDY DESIGN: A retrospective review.
OBJECTIVE: We investigated the longitudinal change of cervical alignment parameters including C2-7 lordosis, C2-7 sagittal vertical axis (SVA), T1 slope, and segmental angle (SA) after two-level anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA: Cervical alignment may influence postoperative clinical outcomes. Several studies have suggested that cervical alignment may serve as a parameter for assessing cervical deformities similar to those used to assess thoracolumbar spine deformities. However, to our knowledge, no studies have investigated the effect of ACDF on cervical sagittal alignment.
METHODS: We enrolled patients whom had ACDF, 23 patients with stand-alone cages and 22 with plate augmentation. Radiologic parameters including C2-7 lordosis, C2-7 SVA, T1 slope, and SA at the operated level were evaluated preoperatively and at 1 week and 6 months postoperatively. The differences between preoperative and 6-month postoperative parameter values were designated as Δvalues. T1S-CL was calculated as the T1 slope minus C2-7 lordosis. Clinical outcome were obtained by the Visual Analog Scale (VAS) and the Neck Disability Index (NDI).
RESULTS: ΔC2-7 SVA was significantly correlated with ΔT1S-CL and ΔC2-7 lordosis. ΔC2-7 lordosis was significantly correlated with ΔSA. ΔC2-7 lordosis had a significantly greater impact on ΔT1S-CL than did ΔT1 slope. The ΔSA and ΔC2-7 lordosis in the ACDF-plate were significantly higher than those in the in ACDF-cage. ΔT1S-CL and ΔC2-7 SVA in the ACDF-plate were significantly lower than those in the ACDF-cage.
CONCLUSION: C2-7 SVA after two-level ACDF was affected more significantly by the SA and C2-7 angle than by the T1 slope. Two-level ACDF with plate restored more cervical lordosis by obtaining more segmental lordosis at the operated level and was more effective in terms of cervical alignment compared with ACDF using stand-alone cages.
LEVEL OF EVIDENCE: 3.

PMID: 27398885 [PubMed – indexed for MEDLINE]

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Temporary Iliac Fixation to Salvage an Acute L4 Chance Fracture: Following Pedicle Screw Fixation for Adolescent Idiopathic Scoliosis.

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Temporary Iliac Fixation to Salvage an Acute L4 Chance Fracture: Following Pedicle Screw Fixation for Adolescent Idiopathic Scoliosis.
Spine (Phila Pa 1976). 2017 Mar;42(5):E313-E316
Authors: Kato …

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Effects of Addition of Preoperative Intravenous Ibuprofen to Pregabalin on Postoperative Pain in Posterior Lumbar Interbody Fusion Surgery.

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Effects of Addition of Preoperative Intravenous Ibuprofen to Pregabalin on Postoperative Pain in Posterior Lumbar Interbody Fusion Surgery.

Pain Res Manag. 2017;2017:1030491

Authors: Pınar HU, Karaca Ö, Karakoç F, Doğan R

Abstract
OBJECTIVE: Ibuprofen and pregabalin both have independent positive effects on postoperative pain. The aim of the study is researching effect of 800 mg i.v. ibuprofen in addition to preoperative single dose pregabalin on postoperative analgesia and morphine consumption in posterior lumbar interbody fusion surgery.
MATERIALS AND METHODS: 42 adult ASA I-II physical status patients received 150 mg oral pregabalin 1 hour before surgery. Patients received either 250 ml saline with 800 mg i.v. ibuprofen or saline without ibuprofen 30 minutes prior to the surgery. Postoperative analgesia was obtained by morphine patient controlled analgesia (PCA) and 1 g i.v. paracetamol every six hours. PCA morphine consumption was recorded and postoperative pain was evaluated by Visual Analog Scale (VAS) in postoperative recovery room, at the 1st, 2nd, 4th, 8th, 12th, 24th, 36th, and 48th hours.
RESULTS: Postoperative pain was significantly lower in ibuprofen group in recovery room, at the 1st, 2nd, 36th, and 48th hours. Total morphine consumption was lower in ibuprofen group at the 2nd, 4th, 8th, 12th, and 48th hours.
CONCLUSIONS: Multimodal analgesia with preoperative ibuprofen added to preoperative pregabalin safely decreases postoperative pain and total morphine consumption in patients having posterior lumbar interbody fusion surgery, without increasing incidences of bleeding or other side effects.

PMID: 28951663 [PubMed – in process]

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[Operative options for failed back surgery syndrome].

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[Operative options for failed back surgery syndrome].

Orthopade. 2016 Sep;45(9):732-7

Authors: Krieg SM, Meyer B

Abstract
BACKGROUND: Post-nucleotomy syndrome includes all existing sequelae after surgical nucleotomy for the resection of a lumbar disc herniation, such as axial lumbar back pain and persisting radiculopathy.
OBJECTIVES: To describe underlying pathologies and to determine operative treatment options.
MATERIALS AND METHODS: Extensive literature research was carried out on Medline.
RESULTS: Various devices and approaches have been developed in the last decades. Nonetheless, surgical and non-surgical therapy of post-nucleotomy syndrome remains complex and frequently fails.
CONCLUSIONS: Better studies providing a better level of evidence for each sub-entity of post-nucleotomy syndrome are required.

PMID: 27541352 [PubMed – indexed for MEDLINE]

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Development of a Predictive Score for Discharge Disposition After Lumbar Fusion Using the Quality Outcomes Database.

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Development of a Predictive Score for Discharge Disposition After Lumbar Fusion Using the Quality Outcomes Database.
Neurosurgery. 2017 Aug 05;:
Authors: Guan J, Knightly JJ, Bisson EF
Abstr…

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Incidence, Risk Factors, and Impact of Clostridium Difficile Colitis After Spine Surgery: An Analysis of a National Database.

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Incidence, Risk Factors, and Impact of Clostridium Difficile Colitis After Spine Surgery: An Analysis of a National Database.

Spine (Phila Pa 1976). 2017 Sep 26;:

Authors: Bovonratwet P, Bohl DD, Russo GS, Ondeck NT, Singh K, Grauer JN

Abstract
STUDY DESIGN: Retrospective study of prospectively collected data.
OBJECTIVE: To utilize a large national database with post-hospitalization follow-up data (National Surgical Quality Improvement Program [NSQIP]) to determine the incidence, risk factors, timing, and clinical impact of C. difficile colitis in spine surgery patients.
SUMMARY OF BACKGROUND DATA: Recent literature has suggested an increased incidence of C. difficile infections. However, there has been a lack of large cohort studies defining the incidence and impact of C. difficile colitis in patients undergoing spine surgery.
METHODS: Patients who underwent spine surgical procedures in the 2015 NSQIP database were identified. The primary outcome was a diagnosis of C. difficile colitis within the 30-day postoperative period. Independent risk factors for development of C. difficile colitis were identified using multivariate regression. Postoperative length of stay and rate of 30-day readmission were compared between patients who did and did not develop C. difficile colitis.
RESULTS: A total of 23,981 patients who underwent spine surgical procedures were identified. The incidence of C. difficile colitis was approximately 0.11% (95% confidence interval [CI], 0.07%-0.16%). Of the cases that developed C. difficile colitis, 70% were diagnosed post-discharge and 88% had not had a pre-existing infection diagnosed. Independent risk factors for the development of C. difficile colitis were combined anterior/posterior lumbar fusion procedures (odds ratio [OR] = 12.29, 95%CI = 2.22-68.13, p = 0.010), greater age (most notably ≥76 years old, OR = 10.31, 95%CI = 3.06-34.76, p < 0.001), hypoalbuminemia (OR = 6.40, 95%CI = 2.49-16.43, p < 0.001), and anemia (OR = 2.39, 95%CI = 1.13-5.05, p = 0.023). The development of C. difficile colitis was associated with greater length of stay (2.2 versus 12.5 days; p < 0.001) and increased 30-day readmission (OR = 8.21, 95%CI = 3.14-21.45, p < 0.001).
CONCLUSIONS: C. difficile was diagnosed in 0.11% of patients undergoing spine surgery. The majority of these cases occurred after discharge and in patients not having prior infection diagnoses. High-risk patients should be monitored and targeted with preventative interventions accordingly.
LEVEL OF EVIDENCE: 3.

PMID: 28953711 [PubMed – as supplied by publisher]

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Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: A prospective cohort study – early results.

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Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: A prospective cohort study – early results.

J Back Musculoskelet Rehabil. 2017 Jun 10;:

Authors: Kapetanakis S, Giovannopoulou E, Charitoudis G, Kazakos K

Abstract
BACKGROUND: Lumbar discectomy is among the most frequently performed procedures in spinal surgery. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive technique that gains ground among surgeons in the recent years. TPED has been studied in terms of effectiveness, however little is known about its overall impact on health-related quality of life (HRQoL) of the patients.
OBJECTIVE: To investigate the progress of HRQoL following TPED.
PATIENTS AND METHODS: Seventy-six (76) patients were enrolled in the study. Mean age was 56.5 ±12.1 years with 38 (50%) males and 38 (50%) females. All patients underwent TPED at L3-L4 (27.6%), L4-L5 (52.6%) and L5-S1 (19.7%). SF-36 was used for the assessment of HRQoL preoperatively and at 6 weeks, at 3, 6 and 12 months after the procedure.
RESULTS: All aspects of SF-36 questionnaire showed statistically significant improvement one year after the procedure (p< 0.001). Role limitations due to physical problems, bodily pain and role limitations due emotional problems showed the highest improvement, followed by physical functioning, vitality, social functioning, mental health and general health.
CONCLUSIONS: TPED for lumbar disc herniation is associated with significant improvement in all aspects of health-related quality of life within 6 weeks postoperatively and the improvement remains significant one year after surgery, as measured by the SF-36 questionnaire.

PMID: 28946526 [PubMed – as supplied by publisher]

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Posterolateral fusion versus dynesys ® dynamic stabilization: retrospective study at a minimum 5.5 years’ follow-up.

Posterolateral fusion versus dynesys ® dynamic stabilization: retrospective study at a minimum 5.5 years’ follow-up.

Orthop Traumatol Surg Res. 2017 Sep 20;:

Authors: Bredin S, Demay O, Mensa C, Madi K, Ohl X

Abstract
INTRODUCTION: Lumbar fusion is one of the most widespread techniques to treat degenerative lumbar pathology. To prevent complications such as non-union or adjacent segment degeneration, dynamic stabilization techniques were developed, but with controversial results. The aim of the present study was to compare long-term radiologic and clinical results between fusion and dynamic stabilization.
MATERIAL AND METHODS: A single-center retrospective study included patients with recurrent lumbar discal hernia or lumbar canal stenosis managed by posterolateral fusion or by dynamic stabilization associated to neurologic release. Patients were seen in follow-up for radiological and clinical assessment: visual analog pain scale (VAS), Oswestry Disability Index (ODI), Short Form-12 (SF-12), adjacent segment disease (ASD), and intervertebral range of motion (ROM).
RESULTS: Fifty-eight 58 patients were included: 25 in the fusion group (FG), and 33 in the Dynesys® group (DG). VAS scores were significantly lower in DG than FG. ODI was 14.6±2.8 in DG, versus 19.4±3.3 in FG (p=0.0001). SF-12 physical subscore was significantly higher in DG. ROM was 4.1±2° in DG, versus 0.7±0.5° in FG (p=0.001). Radiologic ASD was significantly greater in FG than DG (36% vs. 12.1%; p=0.012), without difference in clinical expression (DG, 1 case; FG, 2 cases).
CONCLUSION: Dynamic stabilization provided clinical and radiological results comparable to those of posterolateral fusion in these indications (although level L5-S1 was not studied).

PMID: 28942026 [PubMed – as supplied by publisher]

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Comparison of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion for Single Level Lumbar Degenerative Diseases and Review of Literature.

Comparison of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion for Single Level Lumbar Degenerative Diseases and Review of Literature.

Turk Neurosurg. 2017 Jul 30;:

Authors: Işik HS, Okutan Ö, Yildirim T, Akpinar E, Yilmaz A

Abstract
AIM: There are some recognized treatment modalities in the literature for the treatment of lumbar degenerative diseases,which cause pain and avoidance of daily life activities for the patients.The most widely accepted algorithm in the literature is medical treatment,physical therapy and minimally invasive pain-relieving therapies,if necessary,followed by surgical interventions.The common procedure used in neurosurgery practice is the decompression of neural elements followed by fusion.It is reported in the literature that unilateral pedicle fixation and Transforaminal Lumbar Interbody Fusion(TLIF) procedure have many advantages compared to bilateral pedicle screw implementation(PSF).We examined the clinical and radiological follow-up and results of our patients undergoing fusion procedure by unilateral versus bilateral pedicle screw fixation along with TLIF.
MATERIAL AND METHODS: 54 patients were included in the study.33 patients were operated with bilateral PSF and TLIF and 21 had unilateral PSF and TLIF.The patients were evaluated preoperatively,on the postoperative 15th day,6th and 12th month, and at the time of last examination (38 months in average for all patients) using Visual Analogue Scale(VAS) and Oswestry Disability Index(ODI).Fusion rates were examined with direct X-ray films with flexion-extension dynamic views and 3D CT scan.
RESULTS: Operation times are shorter and blood loss is less in the unilateral PSF group.Fusion rates are similar in both groups with no statistical significance.For both groups significant clinical improvement was observed in the preoperative and postoperative scores.
CONCLUSION: Unilateral PSF along with TLIF procedure is an effective option in selected patients.We need prospective randomized studies with higher number of patients and longer follow-up periods for more reliable results.

PMID: 28944950 [PubMed – as supplied by publisher]

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