Get Ready for 100 Years of Active Spine Life Using Percutaneous Endoscopic Spine Surgery (PESS)

Lumbar spinal stenosis is the most common indication for spinal surgery in patients older than 65 years. After the introduction of Kambin's safety triangle, percutaneous endoscopic spine surgery has started through transforaminal approach for discectomy and is now being extended to spinal stenosis through interlaminar approach, which is an important part of the degenerative spinal disease. With the increase in human longevity, the development of effective treatment for degenerative diseases is inevitable, and future percutaneous endoscopic spine surgery (PESS) will play a very important role in maintaining the health of this ‘super-aged’ population. Endoscopic techniques impart minimal approach related disruption of normal spinal anatomy and function while concomitantly increasing functional visualization and correction of degenerative stenosis. Advantages of full endoscopic spine surgeries are less soft tissue dissection, less blood loss, reduced hospital admission days, early functional recovery and enhancement in the quality of life. With proper training and advancement in equipment and technologies, percutaneous endoscopic spine surgery will be able to successfully treat the aging spine

Selection of fusion levels in adolescent idiopathic scoliosis (AIS) using the fulcrum bending radiograph prediction: verification based on pedicle screw strategy

E-Poster - Adolescent Idiopathic Scoliosis: no. 297Utilizing the fulcrum bending radiographic technique to assess curve flexibility to aid in the selection of fusion levels, a prospective radiographic study was performed to assess the safety and effectiveness of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. This study suggests that ALSS obtains greater deformity correction than hook and hybrid systems, and improves balance without compromising fusion levels.postprin

'Clinical Triad' findings in Klippel-feil patients

E-Poster - Congenital Deformity: no. 530It has been propagated that Klippel-Feil Syndrome (KFS) is associated with the clinical triad findings (CTF) of short neck, low posterior hairline, and limited range of motion. This study noted that CTFs are not consistently noted in KFS patients. KFS patients with extensive congenitally fused cervical segments were more likely to exhibit one of the components of CTF.postprin

The safety and efficacy of a remotely distractible, magnetic controlled growing rod (MCGR) for the treatment of scoliosis in children: a prospective case series with minimum two year follow-up

Concurrent Session 2B - Early Onset Scoliosis: paper no. 26SUMMARY: The growing rod has been the gold standard for the treatment of scoliosis in young children. However, such management requires multiple open surgeries under general anesthesia for rod distraction and is associated with numerous postoperative complications. To avoid such pitfalls, we utilized a magnetically-controlled growing rod (MCGR) implant. Our study found that the MCGR was safe and effective, allowing for distractions on a non-invasive out-patient basis at monthly intervals, eliminating the need for surgeries and their associated complications. Introduction: Traditionally, growing rods are the standard of treatment for young children with severe spinal deformities and significant residual growth potential. However, this requires repeated open distractions under general anesthesia and is associated with numerous post-operative complications. This report addresses the safety and efficacy of the MCGR implant for non-invasive out-patient distractions for scoliosis correction in young children. METHODS: This was a prospective, patient series of the MCGR procedure. From November 2009 to March 2011, five patients (n=3 female; n=2 male) were treated with the MCGR. In this study, we report the first three patients (2 females and 1 male) with minimum 2 years follow-up. All cases were non-invasively distracted using an external magnet on a monthly basis. Pre and post distraction radiographs were carried out to assess the Cobb’s angle, predicted versus achieved rod distraction length and spinal length. Clinical outcome assessment was performed with the pain score (Visual Analogue Scale) and the SRS-30 questionnaire. All procedural or rod related complications were recorded. RESULTS: The main correction of the Cobb’s angle was obtained in the initial surgery and was maintained. The mean monthly increase in T1-T12, T1-S1 and instrumented segment length was 1.6mm, 2.5mm and 1.2mm, respectively. Predicted versus actual length gain per distraction were similar. One case had a superficial wound infection and there was one event of loss of distraction. On last follow-up, no pain was noted and SRS-30 scores remained unchanged to baseline. CONCLUSION: The MCGR is a safe and effective procedure for the surgical treatment of scoliosis in children. The MCGR provides external distractions on an out-patient basis without the need for sedation or anesthesia, and that remote distraction allows more frequent lengthening of the rod that may more closely mimic physiologic growth.postprin

Spine Surgery

We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

The safety and efficacy of mesenchymal stem cells for prevention or regeneration of intervertebral disc degeneration: a systematic review

General Posters: abstract no. GP86INTRODUCTION: Mesenchymal stem cells (MSCs) have been used to halt the progression or regenerate the disc with hopes to prevent or treat discogenic back pain. However, the safety and efficacy of the use of MSCs for such treatment in animal and human models at short and long term assessment (i.e. greater than 48 weeks) have not been systematically addressed. This study addressed a systematic review of comparative controlled studies addressing the use of MSCs to that of no treatment/saline for the treatment of disc degeneration. METHODS: Online databases were extensively searched. Controlled trials in animal models and humans were eligible for inclusion. Trial design, MSC characteristics, injection method, disc assessment, outcome intervals, and complication events were assessed. Validity of each study was assessed addressing trial design. Two individuals independently addressed the aforementioned. RESULTS: Twenty-two animal studies were included. No human comparative controlled trials were reported. All three types of MSCs (i.e. derived from bone marrow, synovial and adipose tissue) showed successful inhibition of disc degeneration progression. From three included studies, bone marrow derived MSC showed superior quality of disc repair when compared to other treatments, including TGF-β1, NP bilaminar co-culture and axial distraction regimen. However, osteophyte development was reported in two studies as potential complication of MSC transplantation. CONCLUSIONS: Based on animal models, the current evidence suggests that in the short-term MSC transplantation is safe and effective in halting disc degeneration; however, additional and larger studies are needed to assess the long-term regenerative effects and potential complications. Inconsistency in methodological design and outcome parameters prevent any robust conclusions. In addition, randomized controlled trials in humans are needed to assess the safety and efficacy of such therapy.published_or_final_versio