The Influence of Multilevel Spinal Deformity Surgery on the EuroQol 5 Dimensions' (EQ-5D) Questionnaire and Residential Status in the Elderly: A Prospective, Observational, Multicenter Study

STUDY DESIGN: Multicenter, international prospective study. OBJECTIVE: This study investigated the clinical outcome up to 2 years after multi-level spinal deformity surgery in the elderly by reporting the minimal clinically important difference (MCID) of EuroQol 5-dimensions (EQ-5D), EQ-VAS, and residential status. METHODS: As an ancillary study of 219 patients ≥60 years with spinal deformity undergoing primary instrumented fusion surgery of ≥5 levels, this study focuses on EQ-5D (3-L) as the primary outcome and EQ-VAS and residential status as secondary outcomes. Data on EQ-5D were compared between pre-operatively and postoperatively at 10 weeks, 12 months, and 24 months. An anchor-based approach was used to calculate the MCID. RESULTS: The EQ-5D index and EQ-VAS, respectively, improved significantly at each time point compared to pre-operatively (from .53 (SD .21) and 55.6 (SD 23.0) pre-operatively to .64 (SD .18) and 65.8 (SD 18.7) at 10 weeks, .74 (SD .18) and 72.7 (SD 18.1) at 12 months, and .73 (SD .20) and 70.4 (SD 20.4) at 24 months). 217 (99.1%) patients lived at home pre-operatively, while 186 (88.6%), 184 (98.4%), and 172 (100%) did so at 10 weeks, 12 months, and 24 months, respectively. Our calculated MCID for the EQ-5D index at 1 year was .22 (95% CI .15-.29). CONCLUSIONS: The EQ-5D index significantly increased at each time point over 24 months after ≥5 level spinal deformity surgery in elderly patients. The MCID of the EQ-5D-3 L was .22. Patients living at home pre-operatively can expect to be able to live at home 2 years postoperatively

Surgical Management of Tuberculosis of the Spine

12th EFORT Congress -- JUN 01-04, 2011 -- Copenhagen, DENMARKWOS: 000302648100008…DePuy, Samo, Zimme

Reconstruction of the Subaxial Cervical Spine Using Lateral Mass and Facet Screw Instrumentation

WOS: 000300872300011PubMed ID: 22218298Study Design. Review article. Objective. To review the indications, technical details, and complications of lateral mass and transfacet mass fixation methods. Summary of Background Data. Potential advantages of rigid fixation in subaxial cervical spine have been defined as early mobilization, faster healing and fusion, and increased fusion rates. Lateral mass screw fixation has been the most popular fixation technique for posterior instrumentation. Transfacet screw fixation, on the other hand, is an alternative method less commonly used. Methods. Narrative and review of the literature. Results. Several different techniques aiming for the most safe and secure lateral mass screw fixation have been described by several different authors. Lateral mass screws provide rigid fixation and high fusion rates in patients with healthy bone. Complications are rare when patients' anatomy is well documented and proper technique is used. Transfacet screw fixation is another method less commonly used and with better biomechanical stability. Conclusion. Lateral mass screw provides excellent 3-dimensional fixations from C3 to C7, and currently it is also the most commonly performed posterior fixation method

Surgical management of post-SCIWORA spinal deformities in children

Background: Patients with spinal cord injury without radiographic abnormality (SCIWORA) are prone to develop spinal deformities. The purpose of this study is to report on the clinical and radiological features of post-SCIWORA spinal deformities. Methods: Four patients with SCIWORA and spinal deformities requiring surgery were analyzed clinically and radiographically. Results: All four SCIWORA patients developed progressive neuromuscular scoliosis. There were 2 males and 2 females. The mean age at spinal cord injury was 3.9 years (range 6 months to 7 years). Spinal deformity was first noticed at a mean of 17 months after their initial injury (range 9 months to 2 years), and surgical intervention was performed at a mean of 6.5 years following their injury (range 4-11 years). The mean preoperative curve was 54° (range 50-62°). The mean postoperative curve was 9.5° (range 5-16°). The level of injury was T5 in two patients, and T10 and L2 in one patient each. All but the lumbar level injury patient had complete paraplegia. One patient with complete injury (T10) and another with incomplete injury (L2) improved neurologically and were able to walk with the aid of orthoses and crutches. Pelvic obliquity improved in all patients following spinal reconstruction surgery, and none of the patients required additional surgery for spinal deformity. The mean postoperative follow-up was 51.75 months (range 24-93 months). Conclusions: Long scoliotic curves extending to the pelvis should be expected in SCIWORA. Early intervention may prevent severe deformities. Modern instrumentation techniques employing pedicle screws provided satisfactory correction, improved hip subluxation, and did not adversely affect the ambulatory ability or functional level of the patients in this series. © 2010 EPOS

Convex Instrumented Hemiepiphysiodesis With Concave Distraction: A Preliminary Report

The convex growth arrest (CGA) procedure has been well accepted for treatment of congenital scoliosis as it is a simpler procedure with successful results. However, unpredictability of curve behavior, slow and usually inadequate correction, and necessity of anterior surgery for completeness of the epiphysiodesis are its shortcomings. In a preliminary study we asked whether a modification of the CGA procedure using convex instrumented hemiepiphysiodesis with concave distraction would correct the coronal plane Cobb angles and would correct or maintain sagittal plane local and global kyphosis angles. We also identified complications. We retrospectively reviewed five female patients who underwent the modified procedure. Their mean age at the index operation was 40 months (range, 17-55 months). The patients underwent concave distractions every 6 months. The magnitude of the convex instrumented and concave distracted curves and sagittal plane parameters were determined on the preoperative and most recent followup radiographs. Minimum followup was 26 months (mean, 34 months; range, 26-40 months). In the coronal plane, the preoperative magnitude of the convex instrumented congenital curve averaged 48A degrees. It was corrected to 36A degrees (25%) postoperatively and was further improved to 27A degrees (44%) at the latest followup. For the distracted segment, the mean preoperative curve was 35A degrees, corrected to 16A degrees postoperatively and to 8A degrees at the latest followup, for an average correction of 77%. Sagittal plane alignment was minimally affected from the procedure. In four of the five patients we identified partial pullout of screws for the concave distraction; these were revised at the time of planned lengthening. This procedure may obviate the need for multiple osteotomies and long thoracic fusions in young children with long sweeping thoracic deformities involving multiple anomalous vertebrae. Implant-related complications on the concave side may be avoided using paired pedicle screws at the proximal and distal anchor sites. Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.Wo

Konjenital Skolyoz Tanı ve Tedavisi

Omurganın en sık görülen konjenital deformitesi konjenital skolyozdur. Deformiteyi oluşturan sebep, oluşum veya ayrışma kusuru veya bu iki bozukluğun birlikte olduğu karma tiptir. Kliniğe yansıması, stabil hemivertebradan, pulmoner, kardiyak, genitoüriner ve nörolojik komplikasyonlara yol açabilen karmaşık ve ilerleyici deformitelere kadar geniş bir aralıktadır. Tabloya sıklıkla diğer organ sistemlerindeki anomaliler eşlik eder. Tanıda; prenatal ultrason, fizik muayene ve röntgen kullanılır. Manyetik rezonans eşlik eden intradural patolojilerin ortaya konulmasında yardımcıdır. Bilgisayarlı tomografi cerrahi planlamada yardımcı olabilir. Tedavi planı eğriliğin yeri ve derecesi, hastanın yaşı, deformitenin tipine ve öngörülen ilerleme beklentisine göre her hastaya özel olarak yapılır. Tedavi temel olarak kontrollü gözlem, konservatif ve cerrahi tedavilerden oluşur. Tek hemivertebra varlığında genellikle erken yaşta hemivertebrektomi ve limitli füzyon önerilir. Daha karmaşık deformitelerde hemiepifizyodez, distraksiyon temelli füzyonsuz cerrahi yöntemler veya bunların kombinasyonları kullanılabilir. Günümüzde teknolojik ilerlemeler sayesinde spinal deformite ve intradural patolojilerin cerrahisi eş zamanlı olarak güvenli şekilde yapılabilmektedir. İhmal edilmiş ileri deformitelerde düzeltici osteotomiler gerekebilir. Düzeltici osteotomiler barındırdıkları nörolojik yaralanma riski ve uygulamadaki teknik zorluklar nedeniyle donanımlı merkezlerde deneyimli cerrahlar tarafından gerçekleştirilmelidir

Congenital kyphosis and spinal stenosis in the adult acondraplasic patient: a case report

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Akondroplazi, otozomal dominant geçiş gösteren en sık görülen kemik displazisi tipidir. Gelişimsel kanal darlığına ek olarak torakolomber kifozun görüldüğü hastalarda, ağır spinal stenoz bulguları oluşabilir. Bu çalışmanın amacı miyelopatik belirti ve bulgularla başvuran otuz yedi yaşındaki erkek akondroplazik hastanın tedavi planlaması ve sonucunun tartışılması amaçlanmıştır.Achondroplasia, the most common cause of skeletal dysplasia, is an autosomal-dominant inherited dwarfism syndrome. Patients that have together developmental spinal stenosis and thoracolumbar kyphosis may shown severe stenotic symptoms. The aim of this study is to present thirtyseven year-old achondroplasic patient and discuss its management and outcome

Short-term X-ray Results of Posterior Vertebral Column Resection in Severe Congenital Kyphosis, Scoliosis, and Kyphoscoliosis

WOS: 000304364800017PubMed ID: 22024907Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection performed on a consecutive series of patients with severe congenital spinal deformity. Summary of Background Data. The treatment of severe congenital spinal deformities is a demanding and difficult surgical challenge. Conventional procedures, such as posterior and anterior instrumentation or combined anteroposterior instrumentation provide limited correction in rigid neglected or maltreated (fused) deformities. Methods. Forty-four patients with severe deformity and managed by posterior vertebral column resection between years 1997 and 2007 having more than 2 years of follow-up were included. Mean age was 8 (range, 2-28) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-in. standing anteroposterior and lateral radiographs obtained before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. Results. Preoperative coronal plane major curve of 106 degrees (range, 90 degrees-132 degrees) with flexibility of less than 30% was corrected to 41.4 degrees (range, 20 degrees-72 degrees), showing a 61% scoliosis correction at the final follow-up. Coronal imbalance was improved by 79% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 87 degrees (range, 67 degrees-103 degrees) in patients with kyphosis was corrected to 36 degrees range, 25 degrees-48 degrees) at the most recent follow-up evaluation. Lumbar lordosis of 27 degrees (range, 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 45 degrees. Complications included postoperative infection in 2 patients, dural laceration in 2 patients, and hemopneumothorax in 1 patient. Conclusion. Posterior vertebral column resection is an effective technique providing a successful correction of stiff complex congenital deformities. However, it is a technically demanding procedure, with possible risks for major complications