Fusion Management Research Articles

Comparative Study of Dynamic Cervical Implant Versus Cervical Interbody Cage Fusion in Management of Degenerative Cervical Disc Disease

Comparative Study of Dynamic Cervical Implant Versus Cervical Interbody Cage Fusion in Management of Degenerative Cervical Disc Disease

Dynamic Cervical Implant versus Cervical Interbody Cage Fusion in Management of Degenerative Cervical Disc Disease

Dynamic Cervical Implant versus Cervical Interbody Cage Fusion in Management of Degenerative Cervical Disc Disease

Fusion rates for conservative and surgical management of type II odontoid fractures and its impact

Background Type II odontoid fractures are known to have low fusion rates following conservative management with a hard collar. However, most patients are elderly with comorbidities and are not fit for surgery. The present study identified the rates of bony fusion, complications, and clinical outcomes following conservative management of type II odontoid fractures. Methods We included consecutive patients referred with a suspected odontoid fracture to a Major Trauma Centre in the UK between March 2015 and December 2017. Data including patient demographics, fracture management, complications and outcomes. Bony fusion was assessed by two neurosurgeons and one neuroradiologists. Results were analysed with simple statistics and chi-squared test. Results 102 patients were included in the study (mean age = 80.4 ± 15.3). 10 (9.8%) were managed surgically and 92 (90.2%) were managed conservatively with a hard collar, for a mean of 87 days. Patients were followed up for a mean of 28.1 months (range 1–855 days) until discharge. 37% developed collar complications, namely pain, stiffness and non-tolerance. Bony union was achieved in 37.3% of patients treated with a hard collar (versus 80% in the surgical group, p = 0.0096). Increasing age was an independent risk factor for non-union (p < 0.001). Of the patients without bony union, none reported symptoms, and 90% were discharged without a collar. Conclusion The management of type II odontoid fractures are difficult in an elderly, co-morbid population. With conservative management fusion rates are low, and collar complications are not insignificant. However, outcomes are good regardless of union.

Oblique lumbar interbody fusion in management of lumbar degenerative spinal stenosis in Chinese population

Purpose: The purpose of this study was to assess the outcomes of a cohort of local Chinese patients who underwent oblique lumbar interbody fusion (OLIF) surgery for lumbar degenerative diseases. Methods: We adopted a minimally invasive anterior approach to the lumbar spine through retroperitoneal access. In the first part of the surgery, a 3- to 5-cm left lateral incision over the abdomen was made guided by imaging. L2–L5 disc space was approached via the corridor between the left psoas muscle and the great vessels. A specially designed interbody cage filled with bone substitute was utilized for interbody fusion. In the second part of the surgery, posterior instrumentation with or without decompression, was performed in a prone position. Efficacy and safety of the surgery were studied. Results: A total of 60 patients with the mean age of 68 years underwent OLIF at 83 surgical levels. Their mean operative time was 79 min, and the average blood loss was 84 ml for the OLIF part. The mean length of hospital stay was 5.5 days. Based on plain computed tomography scan obtained at post-operative 6 months, successful fusion was achieved in 82 of the 83 surgical levels. The Oswestry Disability Index for low back pain had a mean reduction of 22.3% after 6 months. Specific complications observed include transient thigh pain or numbness, retroperitoneal hematoma, post-operative ileus and Bone Morphogenetic Protein (BMP) osteolysis. None of the patients experienced infection, symptomatic pseudo-arthrosis, hardware failure, vascular injury, nerve injury, ureteral injury, bowel injury, incisional hernia or death. Conclusion: OLIF is an effective procedure to treat lumbar spinal stenosis and spondylolisthesis with excellent fusion rate and good functional outcome. Complications specific to this procedure are not uncommon, but majority are minor and self-recovery. Proper training is required to minimize potential surgical risks.

Outcome of transpedicular screw fixation with posterior interbody fusion in management of Spondylolysthesis.

Background: Spondylolysthesis represents a particular and relatively frequent mechanism of intervertebral instability. It could cause low back pain due to forward or anterior displacement of one vertebra in relation the adjacent lower vertebra. There are many treatment intervention. However, there was no consensus on the ideal approach. Aim of the work: To assess the outcome of trans-pedicular screw fixation with posterior inter-body fusion in management of lumber and lumbosacral Spondylolysthesis. Patients and methods: This is prospective study, included twenty patients who underwent surgical lumbar laminectomy and disc removal with lumbar pedicle screw fixation with inter body fusion for patients with Spondylolysthesis who failed conservative measures. Results: The mean preoperative visual analogue score (VAS) for pain was 7.75 ± 0.72 that decreased to 1.35 ± 0.59 at the end of postoperative sixth month, with statistically significant decrease. In addition, the majority of cases had no significant complications, although complication rate was 25%. Conclusion: Posterolateral fusion with pedicle Screws fixation minimizes dislocation, achieves adequate decompression, corrects the sagittal axis, and accomplishes fusion. We successfully achieved solid fusion with good mechanical alignment in majority of the patients.

Surgical Outcome of Fusion in Recurrent Lumbar Disc Herniation

Background Data: Recurrent lumbar disc herniation means re-herniation of disc on the same site and at the same level where a previous discectomy had been performed: recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Tow mean surgical options after reherniated lumbar disc are revision discectomy alone or revision discectomy with fusion discectomy alone in recurrent lumbar disc herniation may not be an efficient treatment without fusion. Objective: To evaluate the efficacy and safety of revision discectomy with fusion in management of recurrent lumbar disc. Study Design: Retrospective study reviewed all patient underwent revision discectomy with fusion, they were 40 patients operated for recurrent lumbar disc from September 2014 to April 2018 in Al-Azhar University Hospital Damietta. Pre- and post-operative data collection and analysis of the outcome were completed based on the “Japanese Orthopedic Association score” (JOAs), and radiographic follow-up. Patients and Methods: 40 patients (30 male and 10 female) underwent revision discectomy with fusion as surgical management for reherniated lumbar disc from September 2014 to April 2018. All patients presented with low back pain and radicular pain with mean duration of 18 months. The patients were investigated by standard plain X-ray CT SCAN and MRI of the lumbar spine. All patients had a discectomy and postero-lateral fusion in revision surgery. These patients followed post operatively clinically for improving pain and neural function, and radiologically for disc removal stability and fusion. Results: The age ranged from 30 to 60 years, mean age was 45 years, male to female ratio 3:1. Follow-up ranged from 18 - 30 months with a mean follow-up 24 months. 30 patients had an excellent outcome, 6 patients had a good outcome, 2 patients had a fair outcome, and 2 patients had a poor outcome. Conclusion: Recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Revision surgery when indicated can be done by various techniques. Revision discectomy with fusion for reherniated lumbar disc is effective and safe with confident results.

Isolated arthroscopic subtalar fusion for management of avascular necrosis of talus

Isolated arthroscopic subtalar fusion for management of avascular necrosis of talus

Percutaneous Pedicle Screw Fixation for Neurologic Intact Thoracolumbar Burst Fractures

Prospective consecutive series. To evaluate the efficacy and safety of percutaneous pedicle screw fixation (PPSF) for thoracolumbar AO type A3 fractures with a specially designed surgical instrument system. Minimally invasive surgery including PPSF is becoming increasingly widespread in the spine surgery. The technique of PPSF was mostly used as supplemental fixation combined with minimally invasive posterior or anterior lumbar interbody fusion in management of lumbar degenerative disorders. There are fewer studies available in literature regarding PPSF without additional kyphoplasty or vertebroplasty for management of thoracolumbar burst fractures. Thirty-six adult patients, who had single thoracolumbar AO type A3 fractures and the load-sharing score of 6 or less, underwent application of percutaneous short-segment pedicle screw fixation. Radiologic parameters including kyphotic angle and vertebral height loss were assessed before and after surgery, and functional outcome was evaluated by Prolo questionnaire. All patients were successfully managed with percutaneous minimal invasive procedures. The average operative time was 78 minutes (range 62 to 117 min). The average intraoperative blood loss was 75 mL (range 50 to 220 mL). After a mean follow-up of 48.5 months (range 32 to 63 mo), 31 of 36 (86.1%) patients had a satisfactory result (19 excellent and 12 good) and 5 of them fair. Our clinical results suggest that PPSF can be an alternative for management of thoracolumbar AO type A3 fractures that have no neurologic deficits. With a specially designed percutaneous instrument and pedicle screw system, the procedure has been proved as relatively safe and a minimally invasive approach for the management of thoracolumbar burst fracture without neurologic deficit.

Central cord injury complicating acute cervical disc herniation in trauma.

A retrospective study on 24 patients with acute central cervical cord injury caused by traumatic disc herniation. To determine the correlation of disc herniation with central cord injury and to evaluate the role of anterior cervical decompression and interbody fusion in management of this injury. Acute cervical disc herniation has been documented as a causative factor in spinal cord injury but has been infrequently reported with central cord syndrome. Between 1989 and 1994, 24 patients with acute cervical disc herniation and central cord syndrome were studied. These patients underwent anterior decompression and fusion, and were followed for 2 to 7 years, with an average follow-up period of 3 years and 8 months. The degree of disc herniation and neurologic scores were rated. During follow-up period, the American Spinal Injury Association motor score in 24 patients was increased to 86.46 +/- 10.22 from 47.79 +/- 19.66. The age of the patients was very negatively correlated with recovery rate (P < 0.01), but no correlation was observed between severity of cord compression and neurologic scores (P > 0.05). Postoperative neurologic improvement in patients with fracture or dislocation was very significantly slower (P < 0.01) than in those without these injuries. Far more common than previously expected, acute disc herniation in cervical spine injury is the one of principal cause for central cord syndrome. Magnetic resonance imaging assessment and surgical intervention are required.