KYPHOPLASTY AND VERTEBROPLASTY IN THE TREATMENT OF OSTEOPOROTIC VERTEBRAL FRACTURES

ABSTRACT Objective: To compare these procedures in the treatment of osteoporotic vertebral compression fractures. Methods: Patients who underwent vertebral augmentation procedures between March 2010 and October 2016 were selected for the study. Kyphosis, anterior vertebral height, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), number of portals, cement volume, and complications were recorded. The results were analyzed by difference of the means. Results: Sixty-eight patients were selected, accounting for 105 procedures. A statistically significant improvement was observed in VAS and ODI with both procedures (p<0.001) without statistically significant difference between them, regardless of the number of portals or cement applied. There was a high correlation between kyphosis correction and ODI improvement (p =0.012). Conclusions: Both vertebroplasty and kyphoplasty are effective procedures for the treatment of vertebral compression fractures. We found no significant difference between both procedures. The high correlation between improvement of kyphosis and ODI suggests that these procedures are better than conservative treatment to improve the quality of life of patients, however more studies are required to reach a final conclusion. Level of Evidence III; Retrospective comparative study

FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

ABSTRACT Objective: To analyze the functional outcome of surgical treatment of cervical spondylotic myelopathy. Methods: A retrospective study involving 34 patients with CSM, operated from January 2014 to June 2015. The neurological status was assessed using the Nurick and modified Japanese Orthopedic Association (mJOA) scales preoperatively and at 12 months. Sex, age, time of evolution, affected cervical levels, surgical approach and T2-weighted magnetic resonance hyperintense signal were also evaluated. Results: A total of 14 men and 20 women participated. The mean age was 58.12 years. The average progression time was 12.38 months. The preoperative neurological state by mJOA was mild in 2 patients, moderate in 16 and severe in 16, with a mean of 11.44 points. The preoperative Nurick was grade II in 14 patients, grade III in 8, grade IV in 10 and grade V in 2. The T2-weighted hyperintense signal was documented in 18 patients (52.9%). The functional outcome according to the mJOA recovery rate was good in 15 patients (44.1%) and poor in 19 (55.9%). The degree of Nurick recovery was good in 20 (58.8%) and poor in 14 (41.2%). Conclusions: Decompressive surgery of the spinal cord has been shown to be effective in the treatment of cervical spondylotic myelopathy in well-selected patients. Although it is suggested that there are certain factors that correlate with functional outcome, we believe that more prospective randomized studies should be conducted to clarify this hypothesis

EFFICACY AND SAFETY OF LUMBAR ARTHROPLASTY IN DEGENERATIVE DISC DISEASE

ABSTRACT Objective: The objective of this longitudinal retrospective study is to assess the efficacy and safety of total lumbar disc replacement in patients with degenerative discopathy (L3-L4, L4-L5, L5-S1). Methods: One hundred and forty-three patients with low back pain, with or without radiculopathy, who met the radiographic criteria underwent anterior arthroplasty between 2000 and 2016. The Oswestry disability index (ODI), the visual analog scale (VAS), patient satisfaction, success criteria, disc height, and range of motion of the operated segment were evaluated preoperatively and at 3, 6, 12, and 24 months following surgery. Results: There were 50 men and 93 women, with an average age of 39.5 years, 13 patients (9%) with previous discectomy. The arthroplasty was performed at level L5-S1 in 97 patients (67.8%), at level L4-L5 in 45 patients (31.5%), and at level L3-L4 in 1 patient. Between the preoperative period and 24 months following surgery, the ODI decreased by 53.86%, the VAS for low back pain decreased by 63.83%, and low back pain with radiculopathy decreased by 60.20%, all statistically significant (p ≤ 0.5). Eighty-two percent of the patients were completely satisfied and 18% were satisfied. There was an average increase in disc height of 12 mm (p <0.001). The range of motion of the affected segment increased by 4° to 7° after surgery (p <0.004). Conclusions: Lumbar arthroplasty of a segment is recommended as an effective treatment for patients with degenerative disc disease with low back pain with or without a root component who meet the inclusion criteria. Level of Evidence III, Systematic reviewb of Level III studies

RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided