Background data: Posterior instrumentation of thoracolumbar burst fracture is an excellent fi xation method. Numerous methods depend on the number of fi xed vertebrae. Both short-segment fi xation, including the fractured vertebra (SSFIS), and long-segment fi xation (LSF) have been widely used with no consensus on the better method. Purpose: This study aims to compare the LSF and SSFIS in thoracolumbar spine fracture in terms of radiological and clinical outcomes. Study design: This is a prospective comparative study. Patients and methods: A total of 20 patients with thoracolumbar burst fractures were treated with posterior pedicle screw fi xation and divided into two groups, with 10 patients each, based on the number of instrumented levels: LSF group and SSFIS group. The patients were evaluated for local kyphotic angle (LKA) correction, anterior vertebral body height loss (AVHL), visual analog scale for back pain, and Oswestry disability index (ODI) for functional outcome. Results: No statistically signi fi cant differences were observed between the two groups regarding patient age, sex, reduction of visual analog scale for back pain, change in functional outcome assessed by ODI postoperatively, correction of LKA, and restoration of AVHL. However, there was a statistically signi fi cant difference favoring the SSFIS group regarding operative time, intraoperative amount of blood loss, incision length, and ODI at the 6-month follow-up. Conclusion: This data suggest that SSFIS seems comparable to LSF in managing thoracolumbar fractures resulting in adequate correction of LKA, restoration of AVHL, and preserving more motion segments.
{"title":"Short-Segment Posterior Fixation with Index Level Screws versus Long-Segment Posterior Fixation in Thoracolumbar Burst Fracture","authors":"M. Saad, Ahmed F. Abdelhady, E. M. Bayomy","doi":"10.57055/2314-8969.1269","DOIUrl":"https://doi.org/10.57055/2314-8969.1269","url":null,"abstract":"Background data: Posterior instrumentation of thoracolumbar burst fracture is an excellent fi xation method. Numerous methods depend on the number of fi xed vertebrae. Both short-segment fi xation, including the fractured vertebra (SSFIS), and long-segment fi xation (LSF) have been widely used with no consensus on the better method. Purpose: This study aims to compare the LSF and SSFIS in thoracolumbar spine fracture in terms of radiological and clinical outcomes. Study design: This is a prospective comparative study. Patients and methods: A total of 20 patients with thoracolumbar burst fractures were treated with posterior pedicle screw fi xation and divided into two groups, with 10 patients each, based on the number of instrumented levels: LSF group and SSFIS group. The patients were evaluated for local kyphotic angle (LKA) correction, anterior vertebral body height loss (AVHL), visual analog scale for back pain, and Oswestry disability index (ODI) for functional outcome. Results: No statistically signi fi cant differences were observed between the two groups regarding patient age, sex, reduction of visual analog scale for back pain, change in functional outcome assessed by ODI postoperatively, correction of LKA, and restoration of AVHL. However, there was a statistically signi fi cant difference favoring the SSFIS group regarding operative time, intraoperative amount of blood loss, incision length, and ODI at the 6-month follow-up. Conclusion: This data suggest that SSFIS seems comparable to LSF in managing thoracolumbar fractures resulting in adequate correction of LKA, restoration of AVHL, and preserving more motion segments.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46079776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Galhom, Abdelrahman Alshawadfy, Mohamed Salah Shater, A. Ramadan, A. Elfadle
Background data: Peripheral nerve injuries by either gunshot missiles or shrapnel from barrel bomb explosions are common during war. Purpose: This article aims to analyze the role and ef fi cacy of movable fi eld hospitals in managing penetrating peripheral limb injuries within a war zone area. Study design: A retrospective descriptive clinical case study was performed. Patients and methods: The authors studied the effect of penetrating peripheral nerve injuries from barrel bomb ex-plosions on 25 (out of 30) patients of any age operated on during a period of 6 months in the Syrian civil war (between October 2012 and March 2013). Surgeries were done in fi eld hospitals along the Syria e Turkey border, and surgeries ranged from neurolysis, end-to-end fascicular, to graft repair under general or local anesthesia. Result: The mean age of the patients was 26.2 ± 7.4 years, and nearly all cases were males except for only one female. The most commonly affected nerve was the radial nerve (28%), followed by the common peroneal nerve (28%). Findings injuries were frequently found near to elbow or knee joints. Most of the injuries of victims (80%) were immediately repaired, and 20% were repaired weeks later after injury. Most cases had primary surgical repair of the nerve (64%), and two cases (8%) had repairs twice owing to an infected wound and a lacerated nerve. The sural graft was done in 16%. Neuromas were found in 20% of cases. The authors were unable to follow-up with all patients, and many patients were lost to follow-up. The most common complication was infection (12%). Complications were signi fi cantly related to wounds nearby joints ( P ¼ 0.043) and associated bone or tendon injuries ( P ¼ 0.012). Conclusion: According to this study, shrapnel injury can cause serious nerve injuries similar to gunshot wounds. A movable fi eld hospital near to war zone area can provide surgical management opportunities for nerve injuries in less critical patients. The most frequently affected site was near the elbow or knee joints. The effects of metal fragments detected near/or inside the nerve and long-term follow-up are major limitations in this study.
{"title":"Extremity Peripheral Nerve Injuries: Is There Any Role of Specialized Field Hospital in the Management of Low-Velocity Penetrating Peripheral Nerve Injuries?","authors":"A. Galhom, Abdelrahman Alshawadfy, Mohamed Salah Shater, A. Ramadan, A. Elfadle","doi":"10.57055/2314-8969.1270","DOIUrl":"https://doi.org/10.57055/2314-8969.1270","url":null,"abstract":"Background data: Peripheral nerve injuries by either gunshot missiles or shrapnel from barrel bomb explosions are common during war. Purpose: This article aims to analyze the role and ef fi cacy of movable fi eld hospitals in managing penetrating peripheral limb injuries within a war zone area. Study design: A retrospective descriptive clinical case study was performed. Patients and methods: The authors studied the effect of penetrating peripheral nerve injuries from barrel bomb ex-plosions on 25 (out of 30) patients of any age operated on during a period of 6 months in the Syrian civil war (between October 2012 and March 2013). Surgeries were done in fi eld hospitals along the Syria e Turkey border, and surgeries ranged from neurolysis, end-to-end fascicular, to graft repair under general or local anesthesia. Result: The mean age of the patients was 26.2 ± 7.4 years, and nearly all cases were males except for only one female. The most commonly affected nerve was the radial nerve (28%), followed by the common peroneal nerve (28%). Findings injuries were frequently found near to elbow or knee joints. Most of the injuries of victims (80%) were immediately repaired, and 20% were repaired weeks later after injury. Most cases had primary surgical repair of the nerve (64%), and two cases (8%) had repairs twice owing to an infected wound and a lacerated nerve. The sural graft was done in 16%. Neuromas were found in 20% of cases. The authors were unable to follow-up with all patients, and many patients were lost to follow-up. The most common complication was infection (12%). Complications were signi fi cantly related to wounds nearby joints ( P ¼ 0.043) and associated bone or tendon injuries ( P ¼ 0.012). Conclusion: According to this study, shrapnel injury can cause serious nerve injuries similar to gunshot wounds. A movable fi eld hospital near to war zone area can provide surgical management opportunities for nerve injuries in less critical patients. The most frequently affected site was near the elbow or knee joints. The effects of metal fragments detected near/or inside the nerve and long-term follow-up are major limitations in this study.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43536848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Sykes, David S. Salven, Troy Q. Tabarestani, M. Khattab, Y. E. Hawary, Jeffrey Gadsen, W. Bullock, M. Berger, M. Abd-El-Barr
Background data: Awake spine surgery has been an area of increasing interest, but it is still relatively uncommon. Purpose: The article aims to review the existing literature to summarize practices, outcomes, and trends in awake spine surgery to determine if awake spine surgery is merely a fad or the future of spine surgery. Study design: A narrative literature review. Patients and methods: The authors performed primary and secondary searches of the PubMed database to reveal works relevant to awake spine surgery. These results, in addition to works known to the authorship, were subjectively selected for inclusion in the narrative review based on relevance to the authors ’ aims. Results: Many types of spine surgery, from the lumbosacral to the cervical spine, can be performed in the awake patient. Anesthetic methods are varied and include, but are not limited to, spinal anesthesia, epidural anesthesia, and truncal blocks. These techniques may be used in isolation or combined. Patients that are ideal candidates for spine surgery have been well described, including patients receiving 1 e 2 level decompressions or fusion. Older patients may be good candidates for awake surgery. The outcomes associated with awake surgery are promising and seem superior to those associated with general anesthesia. There are multiple published protocols and instructions on selecting patients for and safely performing awake spine surgery. The incidence of awake spine surgery is increasing. Conclusion: Awake spine surgery is more than a fad and may be the future of spine surgery.
背景资料：唤醒脊柱手术已经成为人们越来越感兴趣的领域，但它仍然相对罕见。目的：本文旨在回顾现有文献，总结清醒脊柱手术的实践、结果和趋势，以确定清醒脊柱手术是否只是一种时尚或脊柱手术的未来。研究设计：叙事性文献综述。患者和方法：作者对PubMed数据库进行了一次和二次搜索，以揭示与清醒脊柱手术相关的工作。除了作者已知的作品外，这些结果也是根据与作者目标的相关性主观选择纳入叙事评论的。结果：从腰骶到颈椎，许多类型的脊柱手术都可以在清醒的患者身上进行。麻醉方法多种多样，包括但不限于脊椎麻醉、硬膜外麻醉和躯干阻滞。这些技术可以单独使用，也可以组合使用。脊柱手术的理想候选者已经得到了很好的描述，包括接受1 e 2级减压或融合的患者。老年患者可能是清醒手术的好人选。与清醒手术相关的结果是有希望的，并且似乎优于与全身麻醉相关的结果。关于选择患者并安全进行清醒脊柱手术，有多个已发表的协议和说明。清醒脊柱手术的发生率正在增加。结论：唤醒脊柱手术不仅仅是一种时尚，它可能是脊柱手术的未来。
{"title":"Awake Spine Surgery: Fad or Future?","authors":"D. Sykes, David S. Salven, Troy Q. Tabarestani, M. Khattab, Y. E. Hawary, Jeffrey Gadsen, W. Bullock, M. Berger, M. Abd-El-Barr","doi":"10.57055/2314-8969.1271","DOIUrl":"https://doi.org/10.57055/2314-8969.1271","url":null,"abstract":"Background data: Awake spine surgery has been an area of increasing interest, but it is still relatively uncommon. Purpose: The article aims to review the existing literature to summarize practices, outcomes, and trends in awake spine surgery to determine if awake spine surgery is merely a fad or the future of spine surgery. Study design: A narrative literature review. Patients and methods: The authors performed primary and secondary searches of the PubMed database to reveal works relevant to awake spine surgery. These results, in addition to works known to the authorship, were subjectively selected for inclusion in the narrative review based on relevance to the authors ’ aims. Results: Many types of spine surgery, from the lumbosacral to the cervical spine, can be performed in the awake patient. Anesthetic methods are varied and include, but are not limited to, spinal anesthesia, epidural anesthesia, and truncal blocks. These techniques may be used in isolation or combined. Patients that are ideal candidates for spine surgery have been well described, including patients receiving 1 e 2 level decompressions or fusion. Older patients may be good candidates for awake surgery. The outcomes associated with awake surgery are promising and seem superior to those associated with general anesthesia. There are multiple published protocols and instructions on selecting patients for and safely performing awake spine surgery. The incidence of awake spine surgery is increasing. Conclusion: Awake spine surgery is more than a fad and may be the future of spine surgery.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47876996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. F. Allam, M. F. Allam, W. Koptan, T. A. Abotakia
{"title":"Pedicle Screw/Sublaminar Hook Fixation versus Pedicle Screw/Infraspinous Wire Fixation for Spondylolysis Repair: A Retrospective Comparative Study with MSCT Assessment","authors":"A. F. Allam, M. F. Allam, W. Koptan, T. A. Abotakia","doi":"10.57055/2314-8969.1272","DOIUrl":"https://doi.org/10.57055/2314-8969.1272","url":null,"abstract":"","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70940092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Musculocutaneous nerve (MCN) is among the nerves of the anterior compartment of the arm, and it is a mixed nerve derived from the lateral cord of the brachial plexus. Here, in this study, the patient had avulsion of the upper roots of the brachial plexus and was prepared to undergo nerve transfer surgery to innervate the MCN to restore elbow fl exion; its absence was a surprise and a challenge at the same time. This study aims to describe a rare variant of MCN (absence). This is a case report. A 41-year-old male patient had a brachial plexus injury after a road traf fi c accident. He presented with loss of elbow fl exion and prepared for performing neurotization of the MCN. The surgical intervention was performed under general anesthesia without using neuromuscular blocking agents, and the absence of the MCN was noted. Knowledge of the MCN variant is essential, especially if it is the target nerve of surgical intervention.
{"title":"Absence of the Musculocutaneous Nerve While Performing Nerve Transfer Surgery in a Patient with Brachial Plexus Injury, Rare Variant, and Review of Literature","authors":"M. Elsebaey","doi":"10.57055/2314-8969.1268","DOIUrl":"https://doi.org/10.57055/2314-8969.1268","url":null,"abstract":"Musculocutaneous nerve (MCN) is among the nerves of the anterior compartment of the arm, and it is a mixed nerve derived from the lateral cord of the brachial plexus. Here, in this study, the patient had avulsion of the upper roots of the brachial plexus and was prepared to undergo nerve transfer surgery to innervate the MCN to restore elbow fl exion; its absence was a surprise and a challenge at the same time. This study aims to describe a rare variant of MCN (absence). This is a case report. A 41-year-old male patient had a brachial plexus injury after a road traf fi c accident. He presented with loss of elbow fl exion and prepared for performing neurotization of the MCN. The surgical intervention was performed under general anesthesia without using neuromuscular blocking agents, and the absence of the MCN was noted. Knowledge of the MCN variant is essential, especially if it is the target nerve of surgical intervention.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45768794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed K. Elkazaz, A. Abou-Madawi, Hassan A. Alshatoury, Mohamed Alqazaz, A. Abdelmoneam, K. Salem
Background data: The incidence of interbody cage subsidence in oblique lumbar interbody fusion (OLIF) is 8 e 9.5%. It occurs mainly secondary to osteoporosis or end-plate damage during disk space clearance. An anatomical study correlated the surface area contact and position between the cage and the disk space to the incidence of subsidence. Studies have concentrated on the optimal place in the disk space to place the cage to obtain less incidence of subsidence, as it was reported that the central part of the disk space, called the epiphyseal ring, is the toughest part. Subsidence is usually noted in the superior vertebral end plate. Until now, there has been a lack of data regarding the main cause of subsidence. Study design: This is a prospective, clinical case study. Objective: This study aims to assess the subsidence rate in patients undergoing standalone (SA)-OLIF for degenerative lumbar diseases. Patients and methods: Patients with adult degenerative scoliosis following speci fi c inclusion criteria underwent SA-OLIF. The following data were all analyzed and compared statistically: preoperative and postoperative clinical data; back and leg pain visual analog score (VAS) and Oswestry disability index; radiological data; spinopelvic parameters, segmental Cobb ' s angle and anterior disk height, and intraoperative data; operative time; the amount of blood loss; complications (intraoperative or postoperative); and hospital stay. Results: A total of 28 patients and 30 levels were operated on by SA-OLIF, with a mean age of 50.54 ± 6.05, including 14 males and 14 females. The mean operative time/min, blood loss, and hospital stay/day was 91.29 ± 14.23, 195.54 ± 42.299, and 2.78 ± 0.875, respectively. The mean of back pain VAS, the mean of leg pain VAS, and Oswestry disability index changed from preoperatively 7.36 ± 0.98, 6.36 ± 0.911, and 53.71 ± 18.9 to 4.07 ± 1.01, 2.07 ± 0.9, and 45.25 ± 18.76 in 1 year, respectively. Fusion rates were assessed at 6 and 12 months by multislice computed tomography. During the 6-month follow-up period, 83.3% (25 levels) of grade I and grade II fusion was interpreted as solid fusion and 6.6% as cage subsidence (two levels), and during the 12-month follow-up, 89.9% (27 levels) as grade I and grade II fusion and 6.6% cage subsidence (two levels). Conclusion: Subsidence in SA-OLIF highly contributed to end-plate injury during the surgery and osteoporosis; consequently, posterior instrumentation is advised in these patients along with OLIF to decrease the subsidence rate.
{"title":"The Risk of Subsidence in Standalone Oblique Lumbar Interbody Fusion: A 12-Month Follow-Up Prospective Study","authors":"Mohamed K. Elkazaz, A. Abou-Madawi, Hassan A. Alshatoury, Mohamed Alqazaz, A. Abdelmoneam, K. Salem","doi":"10.57055/2314-8969.1266","DOIUrl":"https://doi.org/10.57055/2314-8969.1266","url":null,"abstract":"Background data: The incidence of interbody cage subsidence in oblique lumbar interbody fusion (OLIF) is 8 e 9.5%. It occurs mainly secondary to osteoporosis or end-plate damage during disk space clearance. An anatomical study correlated the surface area contact and position between the cage and the disk space to the incidence of subsidence. Studies have concentrated on the optimal place in the disk space to place the cage to obtain less incidence of subsidence, as it was reported that the central part of the disk space, called the epiphyseal ring, is the toughest part. Subsidence is usually noted in the superior vertebral end plate. Until now, there has been a lack of data regarding the main cause of subsidence. Study design: This is a prospective, clinical case study. Objective: This study aims to assess the subsidence rate in patients undergoing standalone (SA)-OLIF for degenerative lumbar diseases. Patients and methods: Patients with adult degenerative scoliosis following speci fi c inclusion criteria underwent SA-OLIF. The following data were all analyzed and compared statistically: preoperative and postoperative clinical data; back and leg pain visual analog score (VAS) and Oswestry disability index; radiological data; spinopelvic parameters, segmental Cobb ' s angle and anterior disk height, and intraoperative data; operative time; the amount of blood loss; complications (intraoperative or postoperative); and hospital stay. Results: A total of 28 patients and 30 levels were operated on by SA-OLIF, with a mean age of 50.54 ± 6.05, including 14 males and 14 females. The mean operative time/min, blood loss, and hospital stay/day was 91.29 ± 14.23, 195.54 ± 42.299, and 2.78 ± 0.875, respectively. The mean of back pain VAS, the mean of leg pain VAS, and Oswestry disability index changed from preoperatively 7.36 ± 0.98, 6.36 ± 0.911, and 53.71 ± 18.9 to 4.07 ± 1.01, 2.07 ± 0.9, and 45.25 ± 18.76 in 1 year, respectively. Fusion rates were assessed at 6 and 12 months by multislice computed tomography. During the 6-month follow-up period, 83.3% (25 levels) of grade I and grade II fusion was interpreted as solid fusion and 6.6% as cage subsidence (two levels), and during the 12-month follow-up, 89.9% (27 levels) as grade I and grade II fusion and 6.6% cage subsidence (two levels). Conclusion: Subsidence in SA-OLIF highly contributed to end-plate injury during the surgery and osteoporosis; consequently, posterior instrumentation is advised in these patients along with OLIF to decrease the subsidence rate.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47671080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emad H Abouelmmaty, E. H. Sabry, Hisham A Abedelraheem, A. Assar, S. M. Hefni
Background data: The best surgical approach for managing degenerative cervical myelopathy (DCM) remains debatable. Any surgical intervention for DCM aims to provide decompression of adequate neural elements and preserve mechanical stability with the least morbidity and the best long-term outcome. Due to the heterogeneous nature of DCM, multiple approaches and interventions can be used. Purpose: This study aims to compare anterior cervical discectomy and fusion (ACDF) and posterior laminectomy with and without lateral mass fi xation (LMF) in the treatment of DCM regarding radiological and clinical outcomes. Study design: This is a retrospective, case series study. Patients and methods: Twenty patients who underwent ACDF and 20 patients who underwent cervical laminectomy with and without LMF were recruited in this study. Modi fi ed Japanese Orthopedic Association (mJOA) score and myelopathy scale (MS) were used for clinical assessment. Postoperative complications, recovery rate, and operative blood loss are recorded. The cervical curve and canal diameter were assessed. Results: A total of 40 patients were recruited in this study, including 33 males and seven females, with a mean age of 58.8 ± 10.27 years. There was signi fi cant improvement in cervical angle in the anterior group (19.38 ± 3.5 vs. 16.5 ± 6.4, P ¼ 0.043) and canal diameter in the posterior group (9.5 ± 0.76 vs.11.1 ± 1.98, P ¼ 0.01). There were no signi fi cant differences between both groups on the mJOA scale (13.5 ± 4.16 vs. 12.1 ± 1.7, P ¼ 0.197), MS (5.1 ± 1.6 vs. 5.5 ± 1.07, P ¼ 0.341), and complication rate ( P ¼ 0.14). Conclusion: Our data suggest that both anterior and posterior approaches were equivalent in treating DCM. Each case should be evaluated carefully to determine the best surgical approach.
{"title":"Comparative Study between Anterior and Posterior Approaches in the Management of Cervical Spondylotic Myelopathy","authors":"Emad H Abouelmmaty, E. H. Sabry, Hisham A Abedelraheem, A. Assar, S. M. Hefni","doi":"10.57055/2314-8969.1267","DOIUrl":"https://doi.org/10.57055/2314-8969.1267","url":null,"abstract":"Background data: The best surgical approach for managing degenerative cervical myelopathy (DCM) remains debatable. Any surgical intervention for DCM aims to provide decompression of adequate neural elements and preserve mechanical stability with the least morbidity and the best long-term outcome. Due to the heterogeneous nature of DCM, multiple approaches and interventions can be used. Purpose: This study aims to compare anterior cervical discectomy and fusion (ACDF) and posterior laminectomy with and without lateral mass fi xation (LMF) in the treatment of DCM regarding radiological and clinical outcomes. Study design: This is a retrospective, case series study. Patients and methods: Twenty patients who underwent ACDF and 20 patients who underwent cervical laminectomy with and without LMF were recruited in this study. Modi fi ed Japanese Orthopedic Association (mJOA) score and myelopathy scale (MS) were used for clinical assessment. Postoperative complications, recovery rate, and operative blood loss are recorded. The cervical curve and canal diameter were assessed. Results: A total of 40 patients were recruited in this study, including 33 males and seven females, with a mean age of 58.8 ± 10.27 years. There was signi fi cant improvement in cervical angle in the anterior group (19.38 ± 3.5 vs. 16.5 ± 6.4, P ¼ 0.043) and canal diameter in the posterior group (9.5 ± 0.76 vs.11.1 ± 1.98, P ¼ 0.01). There were no signi fi cant differences between both groups on the mJOA scale (13.5 ± 4.16 vs. 12.1 ± 1.7, P ¼ 0.197), MS (5.1 ± 1.6 vs. 5.5 ± 1.07, P ¼ 0.341), and complication rate ( P ¼ 0.14). Conclusion: Our data suggest that both anterior and posterior approaches were equivalent in treating DCM. Each case should be evaluated carefully to determine the best surgical approach.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49391428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Neurotrophins/peptide mixture is a porcine brain-derived peptide preparation with pharmacodynamic properties similar to those of endogenous neurotrophic factors. No study has evaluated the postoperative role of neurotrophins/peptide mixture in the recovery of postdiscectomy motor weakness. Purpose: This study aims to evaluate the effect of postoperative neurotrophins/peptide mixture treatment on the recovery of L5 motor weakness after lumbar discectomy compared with placebo. Study design: A prospective randomized controlled study (preliminary report) was conducted. Patients and methods: In total, 15 patients (group I) with L5 weakness who received a postdiscectomy adjuvant neurotrophins/peptide mixture were compared with group II (15 postdiscectomy patients with L5 weakness) treated with a placebo. The whole patient population was followed up at 2 weeks, 1 month, 3 months, 6 months, and 1 year for assessment of motor recovery. Results: The mean postoperative Medical Research Council score was signi fi cantly improved in both groups; however, the improvement was faster in group I than in group II. The mean Medical Research Council score improvement was signi fi cantly higher in group I than that in group II at 2 weeks, 1 month, 3 months, and 6 months; however, it was statistically insigni fi cant at 1 year. At 1-year follow-up, 80% of cases in group I had improved motor power up to grade 5 compared with 40% of cases in group II. The rest of the patients reached grade 4 in both groups. There was no motor deterioration after improvement in either group. There were no reported drug-related adverse effects in group I. Conclusion: Neurotrophins/peptide mixture may be an ef fi cient and safe adjunctive postoperative treatment for discogenic L5 motor weakness. It may accelerate recovery of nerve injury in an acute setting, which may be a result of accelerating nerve regeneration; however, the overall improvement was comparable to placebo (2022ESJ2601).
{"title":"The Added Value of Postoperative Neurotrophins/Peptide Mixture in Treating L5 Motor Weakness in Lumbar Disc Prolapse: A Preliminary Report of Multicenter Randomized Controlled Study","authors":"Tarek AA Abotakia, Wael MT Koptan, Ahmad FA Allam","doi":"10.57055/2314-8969.1262","DOIUrl":"https://doi.org/10.57055/2314-8969.1262","url":null,"abstract":"Background data: Neurotrophins/peptide mixture is a porcine brain-derived peptide preparation with pharmacodynamic properties similar to those of endogenous neurotrophic factors. No study has evaluated the postoperative role of neurotrophins/peptide mixture in the recovery of postdiscectomy motor weakness. Purpose: This study aims to evaluate the effect of postoperative neurotrophins/peptide mixture treatment on the recovery of L5 motor weakness after lumbar discectomy compared with placebo. Study design: A prospective randomized controlled study (preliminary report) was conducted. Patients and methods: In total, 15 patients (group I) with L5 weakness who received a postdiscectomy adjuvant neurotrophins/peptide mixture were compared with group II (15 postdiscectomy patients with L5 weakness) treated with a placebo. The whole patient population was followed up at 2 weeks, 1 month, 3 months, 6 months, and 1 year for assessment of motor recovery. Results: The mean postoperative Medical Research Council score was signi fi cantly improved in both groups; however, the improvement was faster in group I than in group II. The mean Medical Research Council score improvement was signi fi cantly higher in group I than that in group II at 2 weeks, 1 month, 3 months, and 6 months; however, it was statistically insigni fi cant at 1 year. At 1-year follow-up, 80% of cases in group I had improved motor power up to grade 5 compared with 40% of cases in group II. The rest of the patients reached grade 4 in both groups. There was no motor deterioration after improvement in either group. There were no reported drug-related adverse effects in group I. Conclusion: Neurotrophins/peptide mixture may be an ef fi cient and safe adjunctive postoperative treatment for discogenic L5 motor weakness. It may accelerate recovery of nerve injury in an acute setting, which may be a result of accelerating nerve regeneration; however, the overall improvement was comparable to placebo (2022ESJ2601).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45775961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: The use of less-invasive procedures during surgery for thoracolumbar and lumbar problems has grown in importance. Mini-open or minimally invasive procedures lessen intraoperative bleeding and postoperative back pain compared with open techniques. Uncertainty persists on whether minimally invasive surgeries cause less paraspinal muscle injury than open surgery. According to some reports, compared with open surgery, minimally invasive surgeries might result in less muscle atrophy and fat in fi ltration. Purpose: This study aimed to fi nd whether minimally invasive posterior lumbar spine surgery can lessen paraspinal muscle damage, restrict alterations in muscular structure and function, and improve functional outcomes. Study design: A literature review was performed. Patients and methods: A cross-referencing and extramanual search of the literature in PubMed and MEDLINE, the Cochrane Library databases, and Google Scholar search was conducted. Studies comparing traditional open surgery with minimally invasive or percutaneous procedures were included. In total, 40 studies comparing both techniques were found and analyzed. The muscle state assessment was extended up to 2 years in human studies. Results: A total of 11 studies were conducted on experimental animals, and the remaining studies were either case e control studies, case series, or comparative studies comparing the size of the multi fi dus muscle between patients with various lumbar spine disorders treated either conventionally or using minimally invasive techniques. Conclusion: Even though the degree of evidence is relatively weak, the present study revealed that the minimally invasive posterior spinal techniques have some advantages over the open techniques, such as less damage to the multi fi dus muscle, which is supported by the literature review. The association between changes in muscular structure and pain, strength, and quality of life needs to be better understood via research. These investigations ought to focus on the surgical approach (2022ESJ257).
{"title":"Back Muscles Injury during Posterior Lumbar Spine Surgeries: Minimally Invasive versus Open Approaches—A Review of the Literature","authors":"T. Aly","doi":"10.57055/2314-8969.1259","DOIUrl":"https://doi.org/10.57055/2314-8969.1259","url":null,"abstract":"Background data: The use of less-invasive procedures during surgery for thoracolumbar and lumbar problems has grown in importance. Mini-open or minimally invasive procedures lessen intraoperative bleeding and postoperative back pain compared with open techniques. Uncertainty persists on whether minimally invasive surgeries cause less paraspinal muscle injury than open surgery. According to some reports, compared with open surgery, minimally invasive surgeries might result in less muscle atrophy and fat in fi ltration. Purpose: This study aimed to fi nd whether minimally invasive posterior lumbar spine surgery can lessen paraspinal muscle damage, restrict alterations in muscular structure and function, and improve functional outcomes. Study design: A literature review was performed. Patients and methods: A cross-referencing and extramanual search of the literature in PubMed and MEDLINE, the Cochrane Library databases, and Google Scholar search was conducted. Studies comparing traditional open surgery with minimally invasive or percutaneous procedures were included. In total, 40 studies comparing both techniques were found and analyzed. The muscle state assessment was extended up to 2 years in human studies. Results: A total of 11 studies were conducted on experimental animals, and the remaining studies were either case e control studies, case series, or comparative studies comparing the size of the multi fi dus muscle between patients with various lumbar spine disorders treated either conventionally or using minimally invasive techniques. Conclusion: Even though the degree of evidence is relatively weak, the present study revealed that the minimally invasive posterior spinal techniques have some advantages over the open techniques, such as less damage to the multi fi dus muscle, which is supported by the literature review. The association between changes in muscular structure and pain, strength, and quality of life needs to be better understood via research. These investigations ought to focus on the surgical approach (2022ESJ257).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45253082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Several articles reported on posterior vertebral column resection (PVCR) for correction of thor-acolumbar deformities that followed tuberculous spondylodiscitis, but fewer focused on fi xed lumbosacral deformity secondary to L5 pathology. Study design: A retrospective cohort study was performed. Purpose: This article aimed to determine the degree of spinopelvic parameters correction after PVCR of the fi fth lumbar vertebra (L5) in lumbosacral deformities secondary to pyogenic spondylodiscitis and de fi ne its relation to patients ’ clinical and functional outcomes. Patients and methods: This retrospective study included 12 patients with kyphotic lumbopelvic spinal deformity secondary to healed pyogenic spondylodiscitis at the lumbosacral junction. The study included seven (58.3%) males and fi ve (41.7%) females with a mean age of 37.5 ± 7.61 years. Patients were treated with PVCR. Plain radiography, computed tomography, and MRI were performed on all patients, and the following parameters were measured using the Surgimap (version: 2.2.13) computer program: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and focal deformity angle. Bony fusion is assessed using postoperative radiograph and/or computed tomography. Visual analog scale for both leg and back pain and the Oswestry Disability Index were assessed preoperatively and at the last follow-up. Results: The follow-up period lasted for 16 months (12 e 18). The solid union was achieved in all patients in 8.17 ± 1.52 months with no major postoperative complications. The mean kyphotic deformity was signi fi cantly corrected to ¡ 5.69 ± 6.77 (cid:1) ( P < 0.001). LL signi fi cantly increased to 47.89 ± 3.37 (cid:1) ( P < 0.001). PT decreased signi fi cantly to 17.88 ± 4.132 (cid:1) , and SS increased to 41.13 ± 4.01 (cid:1) . The PI-LL mismatch was corrected to 11.1 ± 4.2 (cid:1) in the fi nal follow-up ( P < 0.001). Oswestry Disability Index improved to 22.50 ± 3.20 postoperatively ( P < 0.001). Conclusion: PVCR provides signi fi cant correction of pelvic parameters and clinical functions of patients with fi xed lumbosacral deformities secondary to pyogenic spondylodiscitis (2022ESJ260).
{"title":"Spinopelvic Balance Restoration Using Posterior Vertebral Column Resection in Fixed Lumbosacral Deformity Following Pyogenic Spondylodiscitis","authors":"M. Saleh, Tarek Elhewala, Sherif A. Alagamy","doi":"10.57055/2314-8969.1265","DOIUrl":"https://doi.org/10.57055/2314-8969.1265","url":null,"abstract":"Background data: Several articles reported on posterior vertebral column resection (PVCR) for correction of thor-acolumbar deformities that followed tuberculous spondylodiscitis, but fewer focused on fi xed lumbosacral deformity secondary to L5 pathology. Study design: A retrospective cohort study was performed. Purpose: This article aimed to determine the degree of spinopelvic parameters correction after PVCR of the fi fth lumbar vertebra (L5) in lumbosacral deformities secondary to pyogenic spondylodiscitis and de fi ne its relation to patients ’ clinical and functional outcomes. Patients and methods: This retrospective study included 12 patients with kyphotic lumbopelvic spinal deformity secondary to healed pyogenic spondylodiscitis at the lumbosacral junction. The study included seven (58.3%) males and fi ve (41.7%) females with a mean age of 37.5 ± 7.61 years. Patients were treated with PVCR. Plain radiography, computed tomography, and MRI were performed on all patients, and the following parameters were measured using the Surgimap (version: 2.2.13) computer program: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and focal deformity angle. Bony fusion is assessed using postoperative radiograph and/or computed tomography. Visual analog scale for both leg and back pain and the Oswestry Disability Index were assessed preoperatively and at the last follow-up. Results: The follow-up period lasted for 16 months (12 e 18). The solid union was achieved in all patients in 8.17 ± 1.52 months with no major postoperative complications. The mean kyphotic deformity was signi fi cantly corrected to ¡ 5.69 ± 6.77 (cid:1) ( P < 0.001). LL signi fi cantly increased to 47.89 ± 3.37 (cid:1) ( P < 0.001). PT decreased signi fi cantly to 17.88 ± 4.132 (cid:1) , and SS increased to 41.13 ± 4.01 (cid:1) . The PI-LL mismatch was corrected to 11.1 ± 4.2 (cid:1) in the fi nal follow-up ( P < 0.001). Oswestry Disability Index improved to 22.50 ± 3.20 postoperatively ( P < 0.001). Conclusion: PVCR provides signi fi cant correction of pelvic parameters and clinical functions of patients with fi xed lumbosacral deformities secondary to pyogenic spondylodiscitis (2022ESJ260).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45672690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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