Posterior Stabilization Research Articles

Functional outcome of posterior decompression and stabilization with PLIF in degenerative lumbar instability

Functional outcome of posterior decompression and stabilization with PLIF in degenerative lumbar instability

Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Posterior Labral Repair for Posterior Glenohumeral Instability

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder pain and dysfunction among young, active populations. Outcomes after posterior stabilization procedures are commonly assessed using patient-reported outcome measures including the Single Assessment Numeric Evaluation (SANE), the Rowe instability score, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale (VAS) for pain. The clinical significance thresholds for these measures after arthroscopic posterior labral repair (aPLR), however, remain undefined. Purpose: We aimed to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the SANE, Rowe score, and ASES score as well as the VAS pain after aPLR. Additionally, we sought to determine preoperative factors predictive of reaching, as well as failing to reach, clinical significance. Study Design: Case-control study; Level of evidence, 3. Methods: This study was a retrospective analysis of patient-reported outcome scores collected from patients who underwent aPLR between January 2011 and December 2018. To determine the clinically significant threshold that corresponded to achieving a meaningful outcome, the MCID, SCB, and PASS were calculated for the SANE, Rowe score, ASES score, and VAS pain utilizing either an anchor- or distribution-based method. Additionally, univariate and multivariate logistic regression analyses were performed to determine the factors associated with achieving, or not achieving, the MCID, SCB, and PASS. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months were available for final analysis. MCID, SCB, and PASS values for the VAS pain were 1.10, 6, and 3, respectively; for the ASES score were 7.8, 34, and 80, respectively; for the SANE were 10.15, 33, and 85, respectively; and for the Rowe score were 11.3, 60, and 90, respectively. To meet the MCID, male sex (odds ratio [OR], 1.1639; P = .0293) was found to be a positive predictor for the VAS pain, and a lower preoperative SANE score (OR, 0.9939; P = .0003) was found to be a negative predictor for the SANE. Dominant arm involvement was associated with lower odds of achieving the PASS for the ASES score (OR, 0.7834; P = .0259) and VAS pain (OR, 0.7887; P = .0436). Patients who reported a history of shoulder trauma were more likely to reach the PASS for the SANE (OR, 1.3501; P = .0089), Rowe score (OR, 1.3938; P = .0052), and VAS pain (OR, 1.3507; P = .0104) as well as the SCB for the ASES score (OR, 1.2642; P = .0469) and SANE (OR, 1.2554; P = .0444). A higher preoperative VAS pain score was associated with higher odds of achieving the SCB for both the VAS pain (OR, 1.1653; P = .0110) and Rowe score (OR, 1.1282; P = .0175). Lastly, concomitant biceps tenodesis was associated with greater odds of achieving the SCB for the ASES score (OR, 1.3490; P = .0130) and reaching the PASS for the SANE (OR, 1.3825; P = .0038) and Rowe score (OR, 1.4040; P = .0035). Conclusion: To our knowledge, this study is the first to define the MCID, SCB, and PASS for the ASES score, Rowe score, SANE, and VAS pain in patients undergoing aPLR. Furthermore, we found that patients who reported a history of shoulder trauma and those who underwent concomitant biceps tenodesis demonstrated a greater likelihood of achieving clinical significance. Dominant arm involvement was associated with lower odds of achieving clinical significance.

Suture Tape Augmentation Improves Posterior Stability After Isolated Posterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Single-Bundle Transtibial Technique

PurposeThe purpose of this study was to assess whether posterior cruciate ligament reconstruction (PCLR) suture tape augmentation can yield more stability after isolated PCLR. MethodsA prospective database was retrospectively reviewed to identified patients that underwent primary isolated PCLR (control study) or isolated PCLR with suture tape augmentation (study group) from January 2016 to September 2020. the subjective International Knee Documentation Committee Subjective (IKDC) Knee, Lysholm and Tegner scores, posterior draw tests, as well as posterior stress radiographs and return to sports activity rates. The minimal clinically important difference (MCID) was used to evaluate the clinically relevance (subjective IKDC, Lysholm and Tegner scores). Results59 were included in this analysis (28 patients in control group, 31 patients in study group). The average length of follow-up was similar between the study and control groups (48.6 vs 47.9months; p=0.800). Knee function, in terms of subjective IKDC (study vs. control: 85.1±6.4 vs. 79.8±6.4; P=0.002), Lysholm (study vs. control: 86.3±7.4 vs. 80.8±7.4; P=0.005) and Tegner (study vs. control: 7.0±1.4 vs. 5.6±1. 7; P=0.006) scores, was significantly improved in the study group. However, the differences between control group and study group were less than the MCID in the subjective IKDC score and Lysholm score. 21.4% (6/28) and 48.4% of patients (15/31) in the control and study groups, respectively, returned to the preinjury sports activity levels (P=0.031). At last follow-up, the mean side-to-side differences in posterior laxity was significantly improved in the study group compared with the control patients (study vs. control: 1.52±0.70 mm vs. 3.17±2.01 mm; p<0.01). ConclusionsPrimary isolated PCLR with suture tape augmentation provides better posterior stability than PCLR without suture tape augmentation at a minimum 2 years follow-up. No differences observed between the groups in the percentage of patients who met or exceeded the MCID in subjective IKDC and Lysholm score.

Cervical Tuberculous Spondylitis

Introduction: Cervical tuberculous spondylitis is a rare disease and low prevalence in all spinal diseases. The cervical region is more vulnerable to volume addition because of tight space in the spinal canal that could damage neurological function. Case description: A 25-year-old female with pain in the posterior of her neck. The pain was accompanied by numbness and tingling that radiated from the hind neck to the left hand. She had no systemic symptoms. She also had a small-sized lump in her hind neck. The patient admitted that she had undergone an antituberculosis drug regimen three months before. The neurological and physical examination revealed hypesthesia in the left upper limb and gibbus in the hind-neck which was approximately one centimeter in diameter. MRI examination revealed that suspicion of cervical tuberculous spondylitis. The patient had undergone debridement laminectomy and posterior stabilization surgery. The pathology impression revealed that supporting tuberculous chronic specific spondylitis. Discussion: Progresivity of abscess led to necrosis of the bone and its surrounding tissue that could cause deformities and neurological symptoms. Conclusion: Cervical tuberculous spondylitis is a very rare case, because it used to be in lumbar or thoracic vertebrae. If this case had been left untreated, it would have a severe prognosis.

Atypical Tibial Fracture Treated with Osteosynthesis Associated with Total Knee Arthroplasty: Case Report.

Bisphosphonates are widely used in the treatment of osteoporosis but predispose the patient to the appearance of atypical fractures. The femoral subtrochanteric region is usually affected, but other bones can be as well. Atypical tibia fractures in patients with severe gonarthrosis is a therapeutic challenge. The present work reports the case of an elderly patient with advanced gonarthrosis who presented atypical tibial fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting with pain and functional limitation resulting from gonarthrosis, which progressed to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion; and fracture in the proximal third of the right tibial diaphysis. The fracture and arthrosis on the right side were treated by osteosynthesis with blocked plaque and total knee arthroplasty with posterior stabilization and fixed base. After physical rehabilitation, significant improvement of pain and function was reported, independent gait was reacquired and a range of motion of 0 to 100° was reached. After one year, the radiographs showed fracture consolidation and satisfactory alignment of the lower limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment difficult. However, the result was satisfactory and the approach with simultaneous osteosynthesis and arthroplasty proved to be adequate.

Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Complications Associated with Oblique Lumbar Interbody Fusion: A Systematic Review

The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion.

Effectiveness of a specific strength program of the gluteus maximus muscle to improve dynamic postural control in female basketball players. A randomized controlled trial

BackgroundBasketball is a team sport in which players perform multidirectional movements, jumps and landings, experiencing abrupt accelerations and decelerations and numerous changes of rhythm. In this sport, speed and intensity are two key factors that are associated with an increased risk of injury. The aim of this randomized controlled trial was to determine the effectiveness of a specific gluteus maximus strength programme as preventive work for young female basketball players, to improve dynamic postural stability and to observe its impact in the rate of lower limb injuries, vertical jump, dynamic knee valgus and pain. Research questionIs effective a strength programme to improve dynamic postural stability, vertical jump and dynamic valgus in female basketball players? MethodsA hundred and thirteen female basketball players that play in professional clubs were recruited, reaching the final stage 92 (46 per group). One group (CG) received conventional injury prevention training while the experimental group (EG) added to the conventional team prevention program, a gluteus maximus strength programme of 5 months composed of 4 exercises/2 days per week/2 sets of 10 repetitions per leg. ResultsThe total injury incidence decreased from 0.33 to 0.16 cases (control group pre=0.43 to post=0.14 cases, EG pre=022 to post=0.19). The EG improved overall (p = 0.000), posterior (p = 0.001), posteromedial (p = 0.001) and posterolateral (p = 0.000) dynamic stability of the right leg; anterior (p = 0.024), medial (p = 0.07) and posteromedial (p = 0.01) of the left leg. Both groups improved vertical jump (GC: p = 0.045 and GE: p = 0.000). There was no significant improvement in pain or valgus. SignificanceThis strength programme is effective in improving dynamic stability especially of the dominant leg and jump height.

Lower Extremity Somatosensory Evoked Potentials Predict Functional Outcomes in Complete Traumatic Cervical Spinal Cord Injury

Traumatic cervical spinal cord injury (tCSCI) is often a debilitating injury, making early prognosis important for medical and surgical planning. Currently, the best early predictors of prognosis are physical examination, imaging studies, and patient demographics. Despite these factors, patient outcomes continue to vary significantly. The purpose of this study was to evaluate the prognostic value of somatosensory evoked potentials (SSEPs) with functional outcomes in tCSCI patients. A retrospective study was conducted on prospectively collected data from 2 academic institutions. Patients 18years and older who had tCSCI and underwent posterior cervical decompression and stabilization with intraoperative neuromonitoring were reviewed. The outcomes of interest were the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA motor score at follow-up. Outcomes measures were assessed via student t-tests, chi-squared tests, and multivariable regression analysis. A total of 79 patients were included. In complete injuries, detectable lower extremity SSEPs were associated with higher ASIA motor scores at follow-up (P= 0.002), greater increases in ASIA motor scores at follow-up (P= 0.009), and a greater likelihood of clinically important improvement in ASIA motor score (P= 0.024). Incomplete, AIS grade C injuries has higher rates of grade conversion (P= 0.019) and clinically important improvement in ASIA motor score (P= 0.010), compared to AIS grade A or B injuries. The detection of lower extremity SSEP signals during initial surgical treatment of tCSCI is associated with greater improvement in ASIA motor scores postoperatively. The association is most applicable to patients with complete injury.

Anesthetic consideration on myeloradiculopathy patient undergoing anterior cervicosternotomy

Myeloradiculopathy, a condition that involves the spinal cord and spinal nerve roots, is the major cause of disability patients. Most patients with myeloradiculopathy receive surgical intervention with the aim of removing the underlying compression injury from the nerve, decompressing the cord, and moving it without friction or further damage. Surgery on the spine and spinal cord has broadened its scope in recent years. The anterior approach is a challenging procedure given the various vascular, osseous, nervous, and articular structures that prevent adequate exposure and the potential damage to anesthetists. Our objective was to evaluate the pre-operative analysis, maintenance during intra-operative care, and post-operative care in patients with myeloradiculopathy undergoing posterior stabilization surgery with an anterior approach (cervicosternotomy). A 23-year-old woman was diagnosed with Myeloradiculopathy at Th2 Vertebrae Level due to space-occupying extradural lesion at Th2-Th4 vertebral level with pathological fracture at Thoracal Th2 et Th7 et Th10 due to suspected spondylitis tuberculosis with paravertebral abscess, with ASA I (Physical Status Classification System). The patient was then treated with laminectomy debridement, abscess drainage, and posterior stabilization through a cervicothoracic spine surgery with an anterior approach. The patient received the preoperative assessment, intraoperative maintenance, and postoperative evaluations, which are very important to ensure a good outcome of the cervicosternotomy with an anterior approach.

Spontaneous improvement of lateral spondylolisthesis on scoliosis after correction of scoliosis deformity

Introduction: By definition, scoliosis is a three-dimensional deformity of the spine. From the etiologic, scoliosis can be divided into three kinds, congenital scoliosis, neuromuscular scoliosis, and the most common type, idiopathic scoliosis. Several patients experience spondylolisthesis concomitant with scoliosis. Understanding the pathoanatomic of these two abnormalities is very important to achieve optimal treatment. The problem lies in the extent to which vertebral instrumentation is necessary.Case presentation: The authors describe five idiopathic scoliosis patients with spondylolisthesis. We also used the Lenke classification to categorize these patients. The patient came with the complaint of a crooked back. All patients did not complain of back pain. The patients were diagnosed with idiopathic scoliosis from the physical and radiological examination. Concomitant spondylolisthesis was found in all five patients. The surgeon decided to perform deformity correction surgery followed by posterior stabilization fusion for scoliosis. There is no specific corrective surgery for the patients' spondylolisthesis.Discussion and Conclusion: Scoliosis has its challenges for orthopedic spine surgeons. Many things must be assessed in scoliosis, such as history, physical examination, full spine x-ray evaluation, Lenke classification, and instrumentation measures. Spondylolisthesis associated with scoliosis generally occurs in the lower lumbar segment. The pathoanatomic of spondylolisthesis concomitant with scoliosis was divided into two kinds and can be grouped according to three theories. Each of these theories will lead to appropriate treatment actions. Deformity correction is aimed at one pathoanatomic but improves both abnormalities if the appropriate treatment is taken.

Intraoperative imaging with the mobile C-arm : Technique, image creation and radiation protection

Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance, documentation and monitoring of the corresponding treatment. Procedures such as open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) of fractures, kyphoplasty and vertebroplasty as well as posterior stabilization of spinal fractures are carried out under X‑ray control. In the relevant operating rooms of emergency departments and operating theaters, mobile fluoroscopy devices are available, which due to their appearance are called C‑arms. These devices can be moved horizontally, vertically, and along the pivotal axis, enabling real-time imaging of joints and bones from various angles. This imaging enables minimally invasive surgical techniques as this often eliminates the need for extensive preparation and resulting in smaller wound defects compared to open surgical preparation. Additionally, surgeons can immediately assess and, if necessary, adjust the reduction outcome to achieve the best possible care and reduce the need for corrective interventions. With current C‑arms it is also possible to generate 3‑dimensional datasets, to enhance the assessment of implant positioning, particularly in complex intra-articular fractures. This availability helps avoid subsequent corrective interventions that would otherwise only be identified through postoperative computed tomography [1].

Favorable short-term outcomes of micronized allogenic cartilage scaffold for glenoid cartilage defects associated with posterior glenohumeral instability

To determine clinical outcomes associated with micronized allogenic cartilage scaffold use for treatment of posterior glenoid cartilage defects at 2 years. Case series. A retrospective analysis of prospectively collected data was performed on a consecutive series of patients who underwent arthroscopic treatment of a symptomatic posterior glenoid cartilage defect with micronized allogenic cartilage scaffold between January 2019 and December 2020. The primary outcome was subjective shoulder value (SSV) at latest follow-up. Secondary outcomes included visual analog scale (VAS), recurrence of instability, and range of motion (ROM). Seven patients, including 4 in the setting of primary posterior instability and 3 in the setting of recurrent symptoms after arthroscopic posterior glenohumeral stabilization, were included in the analysis with a mean follow up of 2.6 years (range, 2-3.7 years). Statistically significant improvements were seen in SSV (median= 40, interquartile range [IQR]= 40-50 before surgery; vs median= 85, IQR= 67.5-87.5 after surgery; P= .018) and VAS (median= 4, IQR= 4-6.3 before surgery; vs median=1, IQR= 0-1.5 after surgery; P= .010). No significant differences were seen in ROM. There were no cases of recurrent instability or reoperation. The use of micronized allogenic cartilage scaffold for glenoid cartilage defects is associated with clinical improvement at 2-year follow-up. This is the case when performed in conjunction with index posterior labral repair when there is a concomitant glenoid cartilage defect or when performed in the setting of persistent pain and mechanical symptoms after prior posterior labral repair. Level IV, therapeutic case series.

Double Limberg Flap for Stage IV Sacral Decubitus Ulcers with Compression Fracture of the First Vertebra of Lumbar Spine: A Case Report

Background: Decubitus ulcers are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. There are numbers of surgical methods have been devised over a year for treatment of decubitus ulcers. Double Limberg flap is our procedure of choice, which we present here as our experience. Case presentation: The study describe a 29 years old male with chief complaint is unable to move both limbs. One month before admission the patient admitted that he had been hit by the roof of the chicken coop while cleaning it. After the incident, the patient wan unable to move his legs. The patient also admitted that he was unable to control his urination and bowel movements. The patient also complained that there were ulcers in the buttocks that were caused by being in bed for a long time. At Dr. Mohammad Hoesin General Hospital, the patient is planned to undergo posterior stabilization. After the posterior stabilization is carried out, this patient was planned to have the ulcer closure using a Limberg flap. The double limber flap survived completely. Flap necrosis was not seen in this case. The largest defect covered by this flap. There was no recurrence of pressure sores in this patient in the 6 month follow-up period. Conclusion: The Limberg flap is a fast, accurate and reliable alternative surgical technique utilizing local tissue in treating sacral decubitus ulcer. Limberg flap repair is an effective technique with short learning curve, patient comfort, early healing, and least complications and recurrence rates are the advantages of this procedure.

Preventive efficacy of ibuprofen and dexamethasone combination for postoperative pain in posterior vertebral stabilization: a randomized controlled study

Background: Posterior vertebral stabilization procedures often cause acute postoperative pain that can turn into chronic pain if not managed adequately. We compared the interleukin 6 (IL-6) level and pain intensity with preventive use of multimodal analgesia with different combinations of intravenous ibuprofen and dexamethasone in these patients.&#x0D; Methodology: Thirty-nine eligible patients were randomized to receive intravenous ibuprofen 400 mg and dexamethasone 10 mg (Group A), ibuprofen 800 mg and dexamethasone 10 mg (Group B), and ibuprofen 800 mg alone (Group C). The study drugs were injected 30 min before surgical procedure followed by fentanyl 24 h postop in a single‑blinded fashion. Serum levels of IL-6 were measured with ELISA. and pain intensity was measured using numeric rating scale (NRS) at preop, then at 2 h and 24 h postoperatively.&#x0D; Results: There was a significant difference in the NRS scores between all treatment groups (P &lt; 0.005) at all measurement times, where Group B had the lowest value. There was a significant difference between IL-6 levels between all treatment groups (P &lt; 0.005) at all measurement times, where Group B had the lowest value at all measurement times. No side effects were observed in all treatment groups.&#x0D; Conclusion: Preventive combination of ibuprofen and dexamethasone has efficacy and safety in managing acute postoperative pain in posterior vertebral stabilization procedures.&#x0D; Abbreviations: COX – Cyclooxygenase; IL-6 - Interleukin 6; MAC - Minimum Alveolar Concentration; NRS - Numeric Rating Scale; NSAIDs - Non-Steroidal Anti-Inflammatory Drugs; PSA - Patient-Controlled Analgesia&#x0D; Key words: Analgesia; Dexamethasone; Ibuprofen; Interleukin-6; Preventive Medicines; Spinal Surgery&#x0D; Citation: Gaus S, Darise SA, Ala AA, Ahmad MR, Musba AT, Tan CW. Preventive efficacy of ibuprofen and dexamethasone combination for postoperative pain in posterior vertebral stabilization: a randomized controlled study. Anaesth. pain intensive care 2023;27(5):548−554; DOI: 10.35975/apic.v27i5.1851&#x0D; Received: March 22, 2023; Reviewed: August 26, 2023; Accepted: September 04, 2023

Endoscopic odontoidectomy for brainstem compression in association with posterior fossa decompression and occipitocervical fusion.

Endonasal endoscopic odontoidectomy (EEO) is an alternative to transoral surgery for symptomatic ventral compression of the anterior cervicomedullary junction (CMJ), allowing for earlier extubation and feeding. Because the procedure destabilizes the C1-2 ligamentous complex, posterior cervical fusion is often performed concomitantly. The authors' institutional experience was reviewed to describe the indications, outcomes, and complications in a large series of EEO surgical procedures in which EEO was combined with posterior decompression and fusion. A consecutive, prospective series of patients who underwent EEO between 2011 and 2021 was studied. Demographic and outcome metrics, radiographic parameters, extent of ventral compression, extent of dens removal, and increase in CSF space ventral to the brainstem were measured on the preoperative and postoperative scans (first and most recent scans). Forty-two patients (26.2% pediatric) underwent EEO: 78.6% had basilar invagination, and 76.2% had Chiari type I malformation. The mean ± SD age was 33.6 ± 3.0 years, with a mean follow-up of 32.3 ± 4.0 months. The majority of patients (95.2%) underwent posterior decompression and fusion immediately before EEO. Two patients underwent prior fusion. There were 7 intraoperative CSF leaks but no postoperative CSF leaks. The inferior limit of decompression fell between the nasoaxial and rhinopalatine lines. The mean ± SD vertical height of dens resection was 11.98 ± 0.45 mm, equivalent to a mean ± SD resection of 74.18% ± 2.56%. The mean increase in ventral CSF space immediately postoperatively was 1.68 ± 0.17 mm (p < 0.0001), which increased to 2.75 ± 0.23 mm (p < 0.0001) at the most recent follow-up (p < 0.0001). The median (range) length of stay was 5 (2-33) days. The median time to extubation was 0 (0-3) days. The median time to oral feeding (defined as, at minimum, toleration of a clear liquid diet) was 1 (0-3) day. Symptoms improved in 97.6% of patients. Complications were rare and mostly associated with the cervical fusion portion of the combined surgical procedures. EEO is safe and effective for achieving anterior CMJ decompression and is often accompanied by posterior cervical stabilization. Ventral decompression improves over time. EEO should be considered for patients with appropriate indications.

Segmental Stabilization of Multilevel Noncontiguous Spinal Fracture

Abstract A multilevel noncontiguous spinal fracture (MNSF) is defined as a spinal injury at two or more levels separated by single or multiple normal vertebrae. We report a case of MNSF having D6, D11, and D12 fractures with AIS-ASIA B. The patient underwent segmented posterior stabilization from D5 to L1 along with decompression at D11. Secondary or tertiary lesions are always overlooked during preliminary physical examination and investigations. Early diagnosis of these lesions and definitive planning before surgery will prevent complication-related lesions or hardware.

Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease.

Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. Surgical treatment of spinal metastatic disease improves patients' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.

Comparison of the Clinical and Radiologic Outcomes of Two Treatment Methods in Patients with Thoracolumbar Junction Distraction Fracture: Short- versus Long-Segment Posterior Stabilization.

We compare the radiologic and clinical results between the short-segment fixation and the long-segment fixation in the thoracolumbar junction distraction fractures. We retrospectively reviewed the prospectively recorded data of patients who underwent posterior approach and pedicle fixation treatment for thoracolumbar distraction fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association AO/OTA 5-B) with a minimum of 2 years of follow-up. A total of 31 patients were operated on; they were divided into two groups: (1) patients treated with short-level fixation (SLF; one level above and below the fracture level) and (2) patients treated with long-level fixation (LLF; two levels above and below the fracture level). The clinical outcomes were evaluated with the neurologic status, operation time, and time to surgery. The functional outcomes were evaluated with the Oswestry Disability Index (ODI) questionnaire and visual analog scale (VAS) at the final follow-up. Radiologic outcomes were measured with the local kyphosis angle, anterior body height, posterior body height, and sagittal index of the fractured vertebra. SLF was performed in 15 patients and LLF was performed in 16 patients. The average follow-up period was 30.13 ± 11.3 months for the SLF group and 35.3 ± 17.2 months for group 2 (p = 0.329). The two groups were similar in regard to age, gender, follow-up period, fracture level, fracture type, and pre- and postoperative neurologic status. The operating time was significantly shorter in the SLF group than in the LLF group. There were no significant differences between the groups in all radiologic parameters, ODI score, and VAS. SLF was associated with a shorter operation time and allowed the preservation of two or more segments of vertebral motion.

Cruciate-substituting and posterior-stabilised total knee arthroplasties had similar gait patterns in the short term.

Surgeons want to achieve native kinematics in primary total knee arthroplasty (TKA). Cruciate-substituting (CS) implants could restore the knee kinematics more efficiently than posterior-stabilised (PS) TKA. This study aimed to compare gait patterns in patients with CS or PS TKA at 6months. The hypothesis was that CS implants would demonstrate comparable gait parameters to PS implants at 6months. In this prospective case-control study, 38 primary TKA without coronal laxity were divided into 2 groups: 19 cruciate-substituting (CS) and 19 posterior-stabilised (PS) implants. The type of prosthesis was determined according to the surgical period. Exclusion criteria were TKA revision, associated procedures and inability to walk on a treadmill. Gait analysis was conducted on a treadmill 6months postoperatively for each patient with a knee assessment device (KneeKG®). Gait characteristics included analysis in three spatial dimensions (flexion-extension, abduction-adduction, internal-external rotation, anterior-posterior translation). Clinical outcomes (Knee Society Score and Forgotten Joint Score) were compared between both groups at 6months postoperatively. At 6months, the gait analysis did not demonstrate any significant difference between CS and PS implants. The range and the maximum anteroposterior translation were similar in both groups (9.2 ± 6.5mm in CS group vs. 8.1 ± 3mm in PS group (n.s.); and - 5.2 ± 5mm in CS group vs. - 6.3 ± 5.9mm in PS group (n.s.), respectively). The internal/external rotation, the flexion, and the varus angle were similar between CS and PS implants. The KSS Knee score was higher at 6months in the CS group than in the PS group (92.1 ± 5.6 vs. 84.8 ± 8.9 (p < 0.01)). Cruciate-substituting and posterior-stabilised TKA had similar gait patterns at 6months postoperatively, despite a non-equivalent posterior stabilisation system. CS prostheses were an interesting option for primary TKA for knee kinematics restoration without requiring a femoral box. Prospective, case-control study; Level II.