Instrumented intervertebral or posterolateral fusion in elderly patients Clinical results of a single center

<p>Abstract</p> <p>Background</p> <p>Data on the clinical outcome after spinal fusion in the elderly patient are rare. To our knowledge there has been no clinical outcome assessment for instrumented spinal fusion in elderly patients comparing posterolateral fusion with intervertebral fusion. Aim of the current study was to evaluate the clinical outcome of elderly patients who underwent a spinal fusion procedure for degenerative spinal stenosis with instability. Main hypothesis was to test whether it is necessary to force an intervertebral fusion for a better clinical outcome in spinal fusion surgery of the elderly or not.</p> <p>Methods</p> <p>Two subgroups - posterolateral fusion versus intervertebral fusion (cage vs. non-cage) were compared with regard to functional outcome, fusion rates and complications after a mean follow up of 3.8 years. Questionnaires were completed by the patients before surgery and at final follow-up. Changes in mean VAS and ODI scores (decrease from the baseline VAS and ODI scores) were compared.</p> <p>Results</p> <p>The mean final follow up for all subjects was 3.8 years. Of the 114 patients, 2 patients were deceased at the time of the follow-up, 5 patients didn't want to participate and 107 patients completed the questionnaires. This resulted in an overall follow-up rate of 93%. At final follow-up, the patients demonstrated significant improvement in the VAS and ODI- compared with the preoperative scores in both groups. But overall there were no significant differences between both groups regarding the outcome assessment using the ODI and VAS.</p> <p>Conclusions</p> <p>The results of this study shows that elderly patients aged over 75 benefit from instrumented lumbar fusion. The study suggests that there is no need to force an intervertebral fusion because elderly patients do not seem to benefit from this procedure.</p

Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients

BACKGROUND CONTEXT: The Thoracolumbar Injury Classification System (TLICS) system has been developed to improve injury classification and guide surgical decision-making, yet validation of this new system remains sparse. PURPOSE: This study evaluates the use of the TLICS in a large, consecutive series of patients. STUDY DESIGN/SETTING: This is a retrospective case series. PATIENT SAMPLE: A total of 458 patients treated for thoracic or lumbar spine trauma between 2000 and 2010 at a single, tertiary medical center were included in this study. OUTCOME MEASURES: American Spinal Injury Association (ASIA) status and crossover from conservative to surgical treatment were measured. METHODS: Clinical and radiological data were evaluated, classifying the injuries by ASIA status, the Magerl/AO classification, and the TLICS system. RESULTS: A total of 310 patients (67.6%) was treated conservatively (group 1) and 148 patients (32.3%) were surgically (group 2) treated. All patients in group 1 were ASIA E, except one (ASIA C). In this group, 305 patients (98%) had an AO type A fracture. The TLICS score ranged from 1 to 7 (mean 1.53, median 1). A total of 307/310 (99%) patients matched TLICS treatment recommendation (TLICS <= 4), except three with distractive injuries (TLICS 7) initially misdiagnosed. Nine patients (2.9%) were converted to surgical management. In group 2, 105 (70.9%) were ASIA E, whereas 43 (29%) had neurological deficits (ASIA A-D). One hundred and three patients (69.5%) were classified as AO type A, 36 (24.3%) as type B, and 9 (6%) as type C. The TLICS score ranged from 2 to 10 (mean 4.29, median of 2). Sixty-nine patients (46.6%) matched the TLICS recommendation; all discordant patients (53.4%) were treated for stable burst fractures (TLICS=2). No neurological complications occurred in either group. CONCLUSIONS: The TLICS recommendation matched treatment in 307/310 patients (99%) in the conservative group. However, in the surgical group, 53.4% of patients did not match TLICS recommendations, all were burst fractures without neurological injury (TLICS=2). The TLICS system can be used to effectively classify thoracolumbar injuries and guide conservative treatment. Inconsistencies, however, remain in the treatment thoracolumbar burst fractures. (C) 2013 Elsevier Inc. All rights reserved.13121760176

Predictive modeling of complications

Predictive analytic algorithms are designed to identify patterns in the data that allow for accurate predictions without the need for a hypothesis. Therefore, predictive modeling can provide detailed and patient-specific information that can be readily applied when discussing the risks of surgery with a patient. There are few studies using predictive modeling techniques in the adult spine surgery literature. These types of studies represent the beginning of the use of predictive analytics in spine surgery outcomes. We will discuss the advancements in the field of spine surgery with respect to predictive analytics, the controversies surrounding the technique, and the future directions

Influência do macheamento na interface do parafuso e do tecido ósseo na fase imediata pós-implante Influencia del taladramiento en la interfase del tornillo y del tejido óseo durante la fase inmediata post implante The influence of tapping techniques on the interface bone screw/bone tissue in immediate postoperative period

OBJETIVO: analisar experimentalmente as alterações agudas da interface entre o osso e o implante nas vértebras cervicais após a realização do macheamento do orifício piloto. MÉTODOS: foram utilizados cinco carneiros da raça Santa Inês deslanados. Na terceira vértebra cervical, foram feitos orifícios de 2,5 mm, de ambos os lados, na parte proximal e distal. No orifício proximal direito, foi realizado o macheamento antes da inserção do parafuso cortical de 3,5 mm (Grupo A); no orifício proximal esquerdo, o parafuso foi inserido sem macheamento (Grupo B); os outros dois orifícios distais foram utilizados como controle (Grupo C). As alterações da interface entre o osso e o implante foram analisadas por meio de estudo histomorfométrico, considerando o número de trabéculas fraturadas entre os filetes de rosca; a maior distância da fratura trabecular transversal provocada pela inserção do parafuso; a maior extensão da fratura trabecular longitudinal provocada pela inserção do parafuso e a linha de contato na interface osso-parafuso. RESULTADOS: o macheamento do orifício piloto provocou alterações da microestrutura do tecido ósseo ao redor do implante quando comparado às alterações produzidas pela inserção do parafuso sem o macheamento ou orifício piloto. A avaliação do contato entre o osso e o implante foi o parâmetro que apresentou diferença estatística na comparação entre a colocação do implante com e sem machemanto. CONCLUSÃO: na comparação com o orifício piloto, todos os parâmetros analisados apresentaram diferença estatística.<br>OBJETIVO: analizar experimentalmente las alteraciones agudas de la interfase entre el hueso y el implante en las vértebras cervicales, después de taladrar el orificio piloto. MÉTODOS: fueron utilizados cinco carneros de la raza Santa Inés sin lana. En la tercera vértebra cervical, fueron realizados en ambos lados unos orificios de 2.5 mm en la parte proximal y distal. En el orificio proximal derecho fue realizado el taladramiento antes de la inserción del tornillo cortical de 3.5 mm (Grupo A), en el orificio proximal izquierdo el tornillo fue insertado sin taladramiento (Grupo B) y los otros dos orificios distales fueron utilizados como controles (Grupo C). Las alteraciones de la interfase entre el hueso y el implante fueron analizadas por medio de un estudio histomorfométrico, teniendo en cuenta el número de trabéculas fracturadas entre los filetes de rosca; la mayor distancia de la fractura trabecular transversal provocada por la inserción del tornillo; la mayor extensión de la fractura trabecular longitudinal provocada por la inserción del tornillo y la línea de contacto en la interfase hueso-tornillo. RESULTADOS: taladrar el orificio piloto ha provocado alteraciones de la microestructura del tejido óseo alrededor del implante cuando comparado con las alteraciones producidas por la inserción del tornillo sin el taladramiento o el orificio piloto. La evaluación del contacto entre el hueso y el implante fue el parámetro que presentó diferencia estadística en la comparación entre la colocación del implante con o sin taladramiento. CONCLUSIÓN: al comparar con el orificio control, todos los parámetros presentaron diferencia estadística.<br>OBJECTIVE: to analyze experimentally the early alterations of the bone-screw interface with tapping techniques in the cancellous bone of the cervical vertebrae. METHODS: five wooless sheep (Santa Inês) were analyzed. Pilot holes of 2.5 mm were performed at both sides of the third cervical vertebrae in the proximal and distal portion. The tapping process was done in the right proximal hole before the 3.5 mm screw insertion (Group A), while the left proximal hole was not tapped (Group B) and the two distal holes were used as control (Group C). The interface alterations between bone and screw were analyzed through histomorphometric study, considering the number of trabeculae fractures between the screw pitch; the highest distance of transversal trabeculae fracture caused by the screw insertion; the greatest extension of the longitudinal trabeculae fracture caused by the screw insertion and the contact line between bone and screw. RESULTS: tapping the pilot hole caused alterations of bone tissue microstructure around the implant, when compared to alterations produced by insertion of the screw, without tapping or pilot hole. The evaluation of the contact between bone and screw was the parameter that presented statistical difference in comparison between the insertion of the implant with and without tapping. CONCLUSION: in comparison with the pilot hole, all the analyzed parameters presented statistical difference