Postoperative American Spinal Injury Association Research Articles

Analysis of risk factors affecting postoperative neurological recovery in patients with cervical spine fracture in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and involves the sacroiliac and peripheral joints. Low-energy trauma can often lead to spinal fractures and spinal cord injuries (SCIs), the treatment of AS is challenging. The prognosis of neurological function in patients with AS cervical fracture and SCI is a major problem that must sought clinician attention on urgent basis. A total of 106 patients with AS cervical fractures who underwent surgical treatment at Shanghai Changzheng Hospital between August 2009 and 2021 were included in this study. All the patients were divided into 2 groups (improved group and the control group) based on their neurological function improvement at 1 year mark after the surgery. The baseline characteristics, perioperative factors, and procedural outcomes of all the patients including injury type, AS drug treatment, the injured segment, ossified anterior longitudinal ligament injury, spinal hypersignal, decompression time window, operation duration, blood loss, preoperative and postoperative American Spinal Injury Association (ASIA) score were recorded and analyzed. Among the 106 patients, 79 demonstrated improved neurological function at 1 year mark after the surgery. Binary univariate logistic regression analysis revealed significant differences in injury type (P = .018), ossified anterior longitudinal ligament injury (P = .01), operation duration (P = .002), spinal hypersignal (P = .001), preoperative ASIA score (P < .001), and prior AS drug treatment (P = .012). No significant differences were observed in the other variables (P > .05). Binary multivariate logistic regression analysis identified spinal hypersignal (OR = 37.185, P = .028), preoperative ASIA score (OR = 0.16, P = .012) and previous AS drug treatment (OR = 0.296, P = .049) as factors associated with postoperative neurological function improvement. The preoperative ASIA score and previous drug treatment of AS were identified as protective factors affecting the improvement of neurological functions in patients with AS cervical fracture after surgery. Preoperative T2-weighted spinal hypersignal was identified as an independent risk factor affecting the improvement of neurological function recovery in patients with AS cervical fracture after the surgery.

Surgical outcome and prognostic factors for 39 recurrent spinal hydatid cysts.

Cystic bone echinococcosis accounts for 0.5-4% of all reported cases, and 45% occur in the spine. Our aim was to review the clinical and radiological features, surgery, and outcomes for 39 patients with recurrent spinal hydatidosis. Thirty-nine reports of patients with recurrent spinal hydatidosis (2011-2020) were followed for an average of 9.28 ± 5.60 months. Lesions occurred in descending order in the; lumbar (48.7%), thoracic (43.6%), and cervical spine (7.7%). Total cyst resection was achieved in 28 of 39 patients (71.8%). Intraoperative cyst rupture occurred in 13 patients (33.3%). The postoperative American Spinal Injury Association (ASIA) score was "good" in 82% of patients. Those with "poor" postoperative ASIA scores had a 41% incidence of recurrent thoracic hydatid cysts; further, they demonstrated significantly higher recurrence rates if cysts had ruptured intraoperatively (P = 0.001). In addition, laminectomy, subtotal original cyst resection (P < 0.007), and a thoracic location were all significantly associated with higher recurrence rates (P < 0.04). The majority of patients demonstrated improvement following surgery for cervical hydatid cysts. Notably, those with poor outcomes typically experienced intraoperative ruptures of their thoracic hydatid cysts, contributing to high cyst recurrence rates.

Treatment and outcomes of patients with metastatic spinal cord compression: a double-center study.

Spinal metastases may only affect the bone tissue and result in spinal instability or may additionally result in epidural compression, leading to neurological deficits. Surgery has emerged as a popular method in treating metastatic epidural spinal cord compression (MESCC) due to the advances in surgical techniques and instrumentation. In this study, we evaluated patients with MESCC regarding neurological status, pain status, and survival rates, and presented our experience managing MESCC. Clinical and radiographic records of 53 patients diagnosed with MESCC between January 2011 and March 2017 were retrospectively evaluated. The study included patients with a pathological diagnosis of primary cancer, those who complained of spinal metastasis, and those who had indications of MESCC on Magnetic Resonance Imaging (MRI). Bone structure and spinal stability were evaluated using assessed Computed Tomography (CT), and metastatic spread was considered using assessed Positron Emission Tomography (PET) in suitable cases. For each patient, the presence of a tumor compressing the spinal cord, age, gender, preoperative, and postoperative American Spinal Injury Association scores (ASIA), Tokuhashi prognostic score (TPS), affected spinal segment, pathological diagnosis, preoperative, and postoperative Visual Analog Scale (VAS), the status of spinal stability, follow-up period, and complications were evaluated. Forty-five patients (82.2% of them were women) underwent surgery with a mean age of 58.29±15.14years. The most frequent type of primary tumor was multiple myeloma (33.9%), followed by lung (24.6%), gastric (7.5%), and prostate (5.7%). The most common site of metastasis was the thoracic region (43.4%), followed by lumbar (24.5%), multiple (24.5%), and cervical (5.7%). The analysis indicated that a significant difference was found between the survival rates of the TPS categories. Common symptoms of MESCC include spinal pain and neurological deficit below the level of the injury. Prompt surgical treatment followed by oncological treatment leads to significant neurological recovery, more prolonged survival, pain relief, and improved quality of life in patients with a short survival time. Oncological treatments, including radiotherapy (RT), should be recommended after surgical treatment.

Intraoperative Neurophysiological Monitoring for Intradural Extramedullary Spinal Tumours.

Retrospective cohort study. Intraoperative neurophysiological monitoring (IONM) is widely used in spinal neurosurgery, particularly for intramedullary tumours. However, its validity in intradural extramedullary (IDEM) spinal tumours is less clearly defined, this being the focus of this study. We compared outcomes for patients that underwent resection of IDEM tumours with and without IONM between 2010 and 2020. Primary outcomes were postoperative American Spinal Injury Association (ASIA) scores. Other factors assessed were use of intraoperative ultrasound, drain placement, postoperative complications, postoperative Eastern Cooperative Oncology Group (ECOG) score, extent of resection, length of hospital stay, discharge location and recurrence. 163 patients were included, 71 patients in the IONM group and 92 in the non-IONM group. No significant differences were noted in baseline demographics. For preoperative ASIA D patients, 44.0% remained ASIA D and 49.9% improved to ASIA E in the IONM group, compared to 39.7% and 30.2% respectively in the non-IONM group. For preoperative ASIA E patients, 50.3% remained ASIA E and 44.0% deteriorated to ASIA D in the IONM group, compared to 30.2% and 39.7% respectively in the non-IONM group (all other patients deteriorated further). Length of inpatient stay was significantly shorter in the IONM group (P = .043). There were no significant differences in extent of resection, postoperative complications, discharge location or tumour recurrence. Research focusing on the use of IONM in IDEM tumour surgery remains scarce. Our study supports the use of IONM during surgical excision of IDEM tumours.

P44. Surgical management of spinal epidural abscess: risk factors and outcomes

<h3>BACKGROUND CONTEXT</h3> A spinal epidural abscess (SEA), a pyogenic infection, can often lead to permanent neurological deficits and mortality. Over the past three decades, the incidence of SEAs, while uncommon, has risen from 0.2-1.0 cases per 10,000 hospital admissions to 2.5-5.1 per 10,000 admissions. Given this rising incidence and potential of SEAs to become a surgical emergency, it is imperative that we develop new methods of prospectively identifying at-risk patients. <h3>PURPOSE</h3> To analyze patient demographics and clinical outcomes of patients undergoing operative management for SEAs in order to decrease diagnostic delay and elucidate factors associated with a better or worse prognosis. <h3>STUDY DESIGN/SETTING</h3> Retrospective study at an academic medical center. <h3>PATIENT SAMPLE</h3> Adult patients (18 and above) treated surgically for SEA. <h3>OUTCOME MEASURES</h3> Patient demographics, LOS, procedures performed, pre-and postoperative American Spinal Injury Association (ASIA) score, comorbidities, lab values. <h3>METHODS</h3> Electronic medical records of patients diagnosed with spinal epidural abscesses and surgically managed from September 2003-December 2021, were reviewed. <h3>RESULTS</h3> A total of 76 patients met our inclusion criteria. A majority were men (46; 60.5%) and Caucasian (62; 81.6%). The mean age on admission was 58.5 years (range: 29-84) and the average LOS was 22 days (SD 20.3 days). The most common location of SEA was in the thoracic spine (26, 34.2%) followed by lumbar (22, 28.9%), cervical (19, 25 %), and multilevel (9, 11.8%) regions. Patient comorbidities included DM (23, 30.3%), IVDU (13, 17.1%) and coexisting infections (53, 69.7%), which included vertebral osteomyelitis (24, 31.6%), bacteremia (25, 32.9%), other abscesses (6, 7.9%) and meningitis (2, 2.6%). Surgical intervention consisted of: transpedicular decompression (n=9 patients, average 1.0 levels), corpectomies (n=17 patients, average 1.2 levels), laminectomies (n =56 patients, average 3.7 levels), discectomies (n=16 patients, average 1.4 levels) and fusions (n=26 patients, average 4.7 levels). Intraoperative complications occurred in 1 (1.3%) patient and involved a dural tear, which was successfully repaired. Average lab values at presentation were WBC (13.8), ESR (80.6) and CRP (171.4). On admission, 13 (17.1%) patients were febrile and 40 (52.6%) had a positive blood culture. The most cultured organisms were MSSA (31; 46.3%) and MRSA (11; 16.4%). Preoperative ASIA scores were ASIA A (4.4%), ASIA B (0.0%), ASIA C (4.4%), ASIA D (26.7%), and ASIA E (64.4%). Postoperative ASIA scores were ASIA A (4.4%), ASIA B (2.2%), ASIA C (2.2%), ASIA D (11.1%) and ASIA E (80.0%). <h3>CONCLUSIONS</h3> Most SEAs occurred in the thoracic and lumbar regions of the spine. Patients typically have a history DM and IVDU and more likely present with coexisting infection, such as bacteremia, vertebral osteomyelitis and other abscesses. S. aureus is the most cultured organism. Most patients present with ASIA D and E scores and are subsequently treated predominantly with laminectomies and fusions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Neurological Impairment Recovery in Surgically Treated Patients With Nontraumatic Spinal Cord Injury.

Introduction:The incidence of nontraumatic spinal cord injury (NTSCI) is reported to be higher than that of traumatic spinal cord injury in many countries, making it an area of growing significance.Objectives:With the aging of the global population in coming decades, it is anticipated that the incidence of NTSCIs will increase dramatically. Our aim was to identify and report the causes, patterns, and outcomes of NTSCI in a tertiary care center.Methods:We have reviewed all adult patients who had a NTSCI and were surgically treated with a minimum follow-up of 12 months postoperatively. Demographic and clinical data were collected. Preoperative and postoperative American Spinal Injury Association (ASIA) impairment scales and past follow-up outcomes were assessed.Results:Of 164 patients, 95 (58%) had full recovery and reached ASIA E score at their last follow-up while 69 (42%) were not able to achieve full recovery till ASIA E score. Urinary incontinence and/or bowel incontinence on admission, degenerative pathologies, and thoracic injury level were all notable indicators of limited ASIA score improvement at the last follow-up.Conclusions:Surgically treated NTSCI could result in good neurological recovery with a low complication rate.

Causes, Patterns, and Outcomes of Nontraumatic Spinal Cord Injury

Introduction: Nontraumatic spinal cord injury (NTSCI), refers to damage to the spinal cord resulting from a cause other than trauma. It is a condition with immense functional implications for individuals involved. The incidence of NTSCI is difficult to estimate due to its heterogeneous cluster of a wide spectrum etiologies with varying pathophysiology. The most described NTSCI causes are degenerative diseases and spinal stenosis, tumors, and inflammatory conditions. In order to avoid delay in diagnosis and time-critical treatment, knowledge of each is important. We aim to fill the gap of knowledge by assessing the causes, patterns, and outcomes of NTSCI.&#x0D; Methodology: This retrospective cohort study included all patients who had an NTSCI between 2016 and 2020. In addition, patients aged &gt;18 years and treated surgically were included. Demographic and clinical data were collected. Pre- and postoperative American Spinal Injury Association (ASIA) impairment scales and last follow-up outcomes were assessed.&#x0D; Result: A total of 124 patients were included. The mean age of our population was 62.8 years with an average BMI of 31; 8% of them were smokers. Upon admission, back pain (45%), numbness (43%), and inability to walk (18%) were the highest recorded clinical presentations. Spinal stenosis (45%) followed by degenerative cervical myelopathy (27%) were the most observed pathologies. Lumbar injuries accounted for 45% whereas cervical injuries accounted for 41% and thoracic injuries for 14%. The average length of stay period was 23.2 days, with 48% of patients transferred to inpatient rehabilitation, and the mean follow-up duration was 15 months.&#x0D; Conclusion: In summary, after assessing the causes, patterns, and outcomes of NTSCI, our study showed that comorbidities were observed in 85% of patients. Spinal stenosis and degenerative cervical myelopathy were the most common etiologies. Patients who presented with urinary incontinence and/or bowel incontinence upon admission had a significantly worse ASIA score at last follow-up. Degenerative pathologies recorded a worse ASIA score, and thoracic injuries recorded the worst ASIA score improvement compared to cervical and lumbar injuries. In total, 57% of the patients showed full recovery at the last follow-up.

Cervical Spine Reconstruction with Chest Tube Technique After Metastasis Resection: A Single-Center Experience

The silastic tube technique, in which a chest tube is placed into the vertebral body defect and impregnated with polymethyl methacrylate, showed good results in patients with lumbar and thoracic neoplastic diseases. There has been only 1 study about the effectiveness and safety of this technique in patients with cervical metastases. We aimed to report our experience in using this technique to reconstruct the spine after corpectomy for cervical metastasis. All patients with cervical spinal metastasis who underwent surgical treatment using a chest tube impregnated with polymethyl methacrylate in conjunction with anterior cervical plate stabilization were retrospectively recruited. Demographics, tumor histology, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, preoperative and postoperative ambulatory status, perioperative complications, and survival time were collected. This study included 16 patients. The most common primary tumor site was the lung (6 patients; 37.5%). The mean (SD) survival time was 408 (795) days (range, 1-2797 days), and the median survival time was 72 days (95% confidence interval 28-116 days). Four patients (25%) died within 30 postoperative days. There was no surgical site infection or instrument failure after the surgery. Five patients (31.2%) lived >180 days, and 3 patients (18.8%) lived >360 days. One patient (6.2%) was still alive at the end of the study. The silastic tube technique in conjunction with anterior cervical plate stabilization might be safe, effective, and cost-effective for patients with cervical spine metastasis.

Does the Region of the Spine Involved with Metastatic Tumor Affect Outcomes of Surgical Treatments?

Spinal metastases occur primarily in the thoracic spine (50%-60%), less commonly in the lumbar (30%-35%), and, infrequently, in the cervical spine (10%-15%). There has been only 1 study with a limited population comparing the postoperative outcome among cervical, thoracic, and lumbar spine metastasis. The aim of this study is to identify whether the region of surgically treated spinal metastasis affects postoperative outcomes. A retrospective study of patients with spinal metastasis was performed. The collected data were as follows: age, gender, smoking history, tumor histology, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, region of spinal metastasis, ambulatory status, surgical approach, surgery time, blood loss, complications, length of hospital stay, postoperative pain relief, postoperative adjuvant therapy, and survival. Data were analyzed to identify the factors affecting the survival and postoperative functional outcome. We studied 191 patients with spinal metastasis including 47 cervical spine metastases, 96 thoracic spine metastases, and 48 lumbar spine metastases, with a mean age of 60.91 ± 9.72 years. The overall median survival was 7 months (95% confidence interval, 2.9-20.63 months). Univariate analysis showed that region of the spine involved with metastasis did not significantly affect the survival and postoperative motor function improvement. Multivariate analysis showed that revised Tokuhashi score, postoperative radiotherapy, and postoperative chemotherapy were independent factors affecting survival. The rate of 30-day complications among patients with different regions of spine metastasis did not reach significance. The postoperative outcomes of patients undergoing surgery for metastases are not affected by the region of the spine.

Surgical Intervention for Patients With Spinal Metastasis From Lung Cancer: A Retrospective Study of 87 Cases.

This was a retrospective study. Evaluate the prognosis and surgical outcomes of patients with spinal metastasis from lung cancer undergoing surgical treatment. The spine is the most common site of metastatic lesions in patients with lung cancer. There have been a few studies, all small cohorts studying prognosis and surgical outcomes and the results were discordant. A retrospective study on a prospectively collected database was conducted. Data collected were the following: age, tobacco use, tumor histology, American Spinal Injury Association score, revised Tokuhashi score, ambulatory status, perioperative complications, postoperative adjuvant treatment, and survival time. Univariate and multivariate analyses were performed to identify the prognostic factors of survival. The authors studied 87 patients with a mean age of 61.3±1.9 years. Median survival was 4.1±0.8 months. Twenty-eight patients (32.2%) lived >6 months and 14 patients (16.1%) lived >12 months. The medical complication rate was 13.8% and the surgical complication rate was 5.7%. The 30-day mortality rate was 4.6%. Univariate analysis showed tobacco use, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy were prognostic factors. There was no significant difference in survival between adenoma lung cancers, nonadenoma lung cancers, and small cell lung cancers (P=0.51). Multivariate analysis revealed tobacco use, revised Tokuhashi score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy affected the survival. This is the largest reported study of patients with spinal metastasis from lung cancer undergoing spinal surgery. It is the first study showing that tobacco use has a negative impact on survival. Spinal surgery improves the quality of life and offers nonambulatory patients a high chance of regaining walking ability with an acceptable risk of complications.

Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study.

Cervical spine blunt trauma patients with the presence of a cerebrovascular injury may be given initiation of heparin anticoagulation treatment prior to necessary surgical stabilization. Literature regarding the safety and efficacy of these procedures while a patient is on active anticoagulation is limited, requiring further investigation. The primary research question for this study is: Can cervical spine decompression and fusion in the context of a blunt cerebrovascular injury and anticoagulation therapy be completed safely? To accomplish this a comparison of outcomes and perioperative complications was made to a control group. A total of 63 trauma patients requiring cervical spine decompression and fusion from 2013 to 2015 were identified at our North American level 1 trauma center. Evaluation of patient injury data, bleeding events, postoperative infections, and neurologic outcomes was collected from chart review. The American Spinal Injury Association (ASIA) grading system was used to measure change in postoperative neurologic outcomes. Of 63 patients, 14 had a concomitant cerebrovascular injury that required perioperative anticoagulation treatment. In the 14 patients receiving anticoagulation, 11 had anterior and 3 had posterior stabilization. A total of 2 patients experienced a complication (pneumonia and hardware failure), but neither was related to anticoagulation. An elevated prothrombin time value was noted postoperatively in 1 patient, but with no adverse outcome. No bleeding or thrombotic events, surgical site infection, or neurologic deterioration occurred. The difference in postoperative ASIA grades between groups was not significantly different (P = .57). The operative cohort receiving anticoagulation therapy did not demonstrate an increase affinity for perioperative complications or a decline in ASIA scores postoperatively when compared to a control cohort. Patients with a cerebrovascular injury receiving anticoagulation treatment can undergo safe and successful cervical spine stabilization procedures. Therapeutic level III.

Surgical Outcomes of Subaxial Cervical Fractures in Patients with Ankylosing Spinal Disorder.

To evaluate the patient groups with ankylosing spinal disorder (ASD) in terms of patients? characteristics, applied surgical approaches, and the outcomes. Between 2008-2019, 50 ASD patients (35?80 years) were operated on subaxial cervical fracture. The mean follow-up time was 48 months. According to the surgical approach, the patients were divided into three groups: patients who only underwent anterior fusion [AF], patients who only underwent posterior fusion [PF], and patients who underwent anteroposterior fusion [APF]. In this retrospective study, we examined the patients? files and outpatient checks to evaluate the history, operations, neurological results, and complications in cases. After undergoing respective surgical interventions, 1 of the 7 patients in the AF group (14%), 2 of the 18 patients in the PF group (18%), and 3 of the 25 patients in the APF group (12%) died. The postoperative American Spinal Injury Association scores were statistically better in all groups than in the preoperative scores. Among the surgical interventions, improvement in the APF group was significantly better than in other groups. Although there is a higher amount of surgery related complications in the APF group, the biomechanical and clinical results are better than the other two surgical interventions.

Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China

ObjectiveThe purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China.MethodsCSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis.ResultsThe ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05).ConclusionACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.

Benefits and Risks of Subsection Laminectomy with Pedicle Screw Fixation for Ossification of the Ligamentum Flavum of the Thoracic Spine: A Retrospective Study of 30 Patients.

BackgroundThis study aimed to evaluate the effectiveness of subsection laminectomy with pedicle screw fixation (SLPF) for the treatment of ossification of the ligamentum flavum of the thoracic spine.Material/MethodsThirty patients (age, 40–71 years) with ossification of the ligamentum flavum of the thoracic spine underwent SLPF (13 men, 17 women). Operative time, intraoperative blood loss, preoperative and postoperative change in thoracic kyphosis, and perioperative complications were recorded. The Japanese Orthopedic Association (JOA) score for severity of myelopathy and the American Spinal Injury Association (ASIA) motor and sensory impairment scale were used before and after surgery.ResultsMean operative time for SLPF was 208.4±38.3 min and mean intraoperative blood loss was 689.3±171.7 ml. The mean JOA score significantly increased from 5.7±1.9 before surgery to 8.8±2.2 at one month after surgery and 9.3±2.7 at the last follow-up (P<0.01). Postoperative improvement in neurological function increased by 68.3±14.4%. The postoperative ASIA grades significantly improved compared with the preoperative grades (P<0.01). The mean local Cobb angle significantly decreased from 17.8±4.3° before surgery to 15.4±3.6° at one month after surgery and 15.8±3.8° at the last follow-up (P<0.01). Three patients (10%) had operative cerebrospinal fluid (CSF) leak. Postoperatively, one patient had neurological deterioration, two patients had deep venous thrombosis (DVT), and one patient developed a wound infection.ConclusionsSLPF was an effective procedure for the treatment of ossification of the ligamentum flavum of the thoracic spine.

Single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis with associated neurological deficit: a multicentre retrospective study

BackgroundA multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit.MethodsThoracolumbar junction (T12-L1) tuberculosis patients (n = 69) with neurological deficit who underwent single-stage posterior debridement, decompression and transpedicular screw fixation from January 2005 to January 2015 were included in the study. Antituberculosis therapy was performed both before and after surgery. The surgery duration and patient blood loss were evaluated, in addition to the change in pain visual analogue score (pVAS), kyphotic angle, Oswestry disability index (ODI) score and American Spinal Injury Association (ASIA) grade assessed preoperatively, immediate postoperatively and at the final follow-up visit.ResultsThe average blood loss was 354 ± 291 mL. The average kyphosis angle was corrected from 21 ± 9° preoperatively to 9 ± 4° postoperatively, with a mean decrease in pVAS and ODI scores of 3.4 and 16, respectively. The postoperative ASIA grading was grade A for five patients, grade C for 15 and grade D for 49 patients, which had improved to grade C for four patients, grade D for three patients and grade E for 62 patients at the final follow-up. The neurological deficit did not worsen in any of the patients.ConclusionsSingle-stage posterior debridement, decompression and transpedicular screw fixation is an effective treatment method in thoracolumbar junction (T12-L1) tuberculosis patients with neurological deficit, with good neurological recovery and no progression of kyphosis.

Intraoperative Neuromonitoring (IONM): Is There a Role in Metastatic Spine Tumor Surgery?

A retrospective design. We aim to report our experience with multimodal intraoperative neuromonitoring (IONM) in metastatic spine tumor surgery (MSTS). IONM is considered as standard of care in spinal deformity surgeries. However, limited data exist about its role in MSTS. A total of 135 patients from 2010 to 2017, who underwent MSTS with IONM at our institute, were studied retrospectively. After excluding seven with no baseline signals, 128 patients were analyzed. The data collected comprised of demographics, pre and postoperative American Spinal Injury Association (ASIA) grades and neurological status, indications for surgery, type of surgical approach. Multimodal IONM included somatosensory-evoked potentials (SSEPs), transcranial electric motor-evoked potentials (tcMEP), and free running electromyography (EMG). The 128 patients included 61 males and 67 females with a mean age of 61 years. One hundred sixteen underwent posterior procedures; nine anterior and three both. The frequency of preoperative ASIA Grades were A = 0, B = 0, C = 10, D = 44, and E = 74 patients. In total, 54 underwent MSTS for neurological deficit, 66 for instability pain, and 8 for intractable pain.Of 128 patients, 13 (10.2%) had significant IONM alerts, representing true positives; 114 true negatives, one false negative, and no false positives. Among the 13 true positives, four (30%) underwent minimally invasive and nine (70%) open procedures. Eight (69.2%) patients had posterior approach. Seven (53.84%) true positive alerts were during decompression, which resolved to baseline upon completion of decompression, while five (38.46%) were during instrumentation, which recovered to baseline after adjusting/downsizing the instrumentation, and one (8.3%) during lateral approach, which reversed after changing the plane of dissection. Of the seven patients without baseline, five were ASIA-A and two were ASIA-C. The sensitivity, specificity, positive, and negative predictive values were 99.1%, 100%, 100%, and 92.9%, respectively. Multimodal IONM in MSTS helped in preventing postoperative neurological deficit in 9.4% of patients. Its high sensitivity and specificity to detect intraoperative neurological events envisage its use in ASIA-grade D/E patients requiring instrumented decompression. 3.

Outcomes of Posterior Thoracic Corpectomies for Metastatic Spine Tumors: An Analysis of 90 Patients

To retrospectively analyze the outcomes and complications of patients with metastatic thoracic spinal tumors (MTTs) who underwent posterior corpectomies. Ninety patients with MTTs who underwent posterior corpectomies were retrospectively analyzed. Characteristics evaluated included number of MTTs per year, location, involved vertebrae numbers, sex, histology, pre- and postoperative American Spinal Injury Association (ASIA) grade, visual analog scale (VAS) pain scores, operative time, blood loss, and length of hospital stay. The average follow-up was 20.8 ± 27.9 months (range, 0.5-139.4 months). Of the patients, 76.67% had a single metastasis and 23.33% had multiple metastases. For histology, 16.67% were breast, 15.56% were lung, 12.22% were prostate, and 12.22% were renal cell carcinoma. Of the patients with paraplegia and paraparesis, 74% improved. One patient improved from ASIA grade A to D, 3 patients improved from grade B to C, 8 patients improved from grade C to D or E, and 25 patients improved from grade D to E. Three patients (6%) with ASIA grade A and 1 patient (2%) with ASIA grade B had no improvement. One patient with ASIA grade C and 8 patients (16%) with grade D had no improvement. After surgery, VAS pain scores decreased from 8.45 ± 1.57 to 1.211 ± 1.81. In terms of complications, 2 patients (2.22%) had deep vein thrombosis and 1 patient had pulmonary embolism (1.11%). Other complications included wound infection (4.44%), cerebrospinal fluid leak (4.44%), pleural effusion (3.33%), wound dehiscence (2.22%), cellulitis (1.11%), epidural hematoma (1.11%), and pneumothorax (1.11%). Of the patients, 2.22% had implant failure and pseudoarthrosis, with 1 patient needing revision surgery. One patient (1.11%) had tumor recurrence. Our results suggest that posterior thoracic corpectomies for MTTs have a reasonable complication rate with favorable outcomes.

Advantage of ABCD classification in guiding diagnosis and treatment of cervical spinal cord injury without fracture or dislocation

Objective To explore whether the ABCD classification has any advantage over the subaxial cervical spine injury classification (SLIC) in the treatment of cervical spinal cord injury without fracture or dislocation. Methods Included in this study were 118 patients who had been treated for cervical spinal cord injury without fracture or dislocation from January 2012 to December 2016.They were 98 men and 20 women, aged from 18 to 78 years (average, 50.1 years).Of them, those admitted from January 2012 to June 2014 were diagnosed and treated according to the SLIC while those admitted from July 2014 to December 2016 were diagnosed and treated by the ABCD classification.After a retrospective re-evaluation of the 118 cases was conducted using the classification other than their original one, 30 cases were identified who showed discrepancy in the guidance indicated by the classification.Conservative treatment had been suggested for them by the SLIC but surgical treatment was suggested by the ABCD classification.Actually, 16 of them had been treated conservatively and 14 surgically.The 2 groups of the 30 cases were compared in terms of pre- and post-operative American Spinal Injury Association (ASIA) and Japanese Orthopedic Association (JOA) scores. Results The 30 patients were followed up for 12 to 48 months (average, 20 months). Ten of them obtained one grade ASIA improvement (4 in the conservative group and 6 in the surgical group) one year after operation. The JOA improvement rate for the conservative group (40.58%±23.02%) was significantly lower than that for the surgical group (61.44%±27.06%) (Z=-2.085, P=0.037). Their gender, age, or operative procedure was not significantly correlated with their treatment results (P>0.05), but their conservative or surgical treatment was significantly correlated with their treatment results (χ2=5.000, P=0.025). Conclusion The ABCD classification may have an advantage over the SLIC in the treatment of cervical spinal cord injury without fracture or dislocation, because it may lead to better neural functional recovery due to the more appropriate treatment protocol it may provide than the SLIC. Key words: Spinal cord injury; Therapy; Surgical procedures, operative; Injury classification

Secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy for irreducible atlantoaxial dislocation

Objective To explore the clinical efficacy of secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy for treatment of irreducible atlantoaxial dislocation. Methods From January 2014 to May 2016, 12 patients with irreducible atlantoaxial dislocation were treated with secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy in our hospital. They were 7 males and 5 females, with an average age of 37.1 years (from 25 to 54 years). The efficacy was analyzed in terms of their visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scoring, improvement rate of neurological function, American Spinal Injury Association (ASIA) grading, atlas-dens interval (ADI), space available for the cord (SAC) and cervicomedullary angle (CMA) before and one year after operation. Results The patients were followed up for more than one year.All the atlantoaxial joints obtained anatomic reduction. Their preoperative values of VAS (5.73±1.36 points), JOA score (9.03±2.12 points), ADI (8.34±1.12 mm), SAC (9.53±0.69 mm) and CMA (121.23°±4.32°) were significantly improved one year after operation (1.21±0.63 points, 14.32±2.51 points, 2.83±0.36 mm, 14.23±1.22 mm and 153.53°±9.25°, respectively) (P<0.05). The improvement rate of neurological function increased gradually with the postoperative time, reaching 94.14%±5.11% one year after operation. The postoperative ASIA grading was significantly improved too one year after operation (P<0.05). Conclusion Secondary posterior internal fixation after transoral anterior atlantoaxial release under 3D operative microscopy may lead to fine clinical efficacy one year after operation for patients with irreducible atlantoaxial dislocation. Key words: Atlantoaxial joint; Dislocation; Skeletal tracting reposition; Posterior fixation

Radiographic and Neurological Outcome After Surgical Treatment of Traumatic Fractures of the Ankylotic Thoracic Spine: A Retrospective Case Series.

Spontaneous thoracic ankylosis is a progressive degenerative process that predisposes patients to potentially highly unstable traumatic injuries. Acute hyperextension fractures result in dynamic instability putting the spinal cord at risk. To describe preoperative radiographic characteristics of fractures of the ankylotic thoracic spine and relate findings to early postoperative radiographic and clinical outcomes. A single center, retrospective review was performed of 28 surgically treated patients with fractures of the ankylotic thoracic spine. Radiographic assessment included preoperative fracture angulation (FA) and fracture displacement (FD), and postoperative change in sagittal alignment. Early clinical outcomes included preoperative and postoperative American Spinal Injury Association (ASIA) grade and perioperative complications. Seven patients (25%) presented with poor neurological grade (ASIA A-C) compared to 21 (75%) with good grade (ASIA D, E). At presentation, poor grade patients had a mean FA of 16.4° (range 0°-34.5°), and FD of 7.76 mm (range 0.8-9.2). Good grade patients had a mean FA of 18.2° (range 0°-43.3°), and FD of 4.77 mm (range 0-25.1). There was no statistically significant difference in FA or FD between groups (P = .70 and .20 respectively). All underwent posterior pedicle screw fixation for stabilization. Fifty per cent of patients presenting with ASIA C or D spinal cord injury improved 1 or more ASIA grades. There were no perioperative complications. Early postoperative sagittal alignment was maintained with a mean change of -2.6°. Presenting fracture alignment does not significantly correlate with pre- or postoperative neurological status. Early posterior stabilization preserved neurological function, with neurological recovery occurring in a portion of individuals.