Pub Date : 2019-07-01DOI: 10.21608/esj.2020.8121.1099
H. Elsobky, A. Zidan, A. Khalil, A. Elsobky
Background Data: Unfortunately, large anterior cervical osteophytes are a forgotten cause of dysphagia and dyspnea. They can cause marked change in diet habits or interfere with patients’ daily activities and sleep without significant neck pain or radicular pain. Diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, degenerative changes, and prior trauma including surgery can cause cervical osteophytes. Conservative medical treatment and diet modification may be a useful option when treating these patients; however, surgery may be mandatory, in particular with sever progressive symptoms not responding to conservative measures with excellent results and accepted incidence of complications. Study Design: This is a retrospective clinical case study. Purpose: To highlight this uncommon cause of dyspnea and dysphagia and define the possible management strategies. Patients and Methods: This study was conducted in Mansoura University Hospital on nine patients presented with dysphagia, dyspnea, or both. The cause of their symptoms was large anterior cervical osteophytes. Six patients were males and 3 were females with their age ranged from 53 to 75 years. All patients were assessed by X-ray, CT, and MRI of the cervical spine and underwent fiber optic nasoendoscopy to assess posterior pharyngeal wall and other causes of upper airway obstruction. All patients had a trial of conservative measures including anti-inflammatory, antireflux medication, corticosteroids, diet modification, and consultations with specialists in rheumatology and speech and swallowing therapy. Results: Of the 9 patients, three patients improved on the above-mentioned conservative measures, and one patient who presented with stridor underwent urgent tracheostomy and refused further surgery. Five patients who failed conservative therapy for at least three months underwent surgical excision of their osteophytes through anterior cervical approach. Improvement of surgical group was satisfactory according to the Dysphagia Scoring System. Conclusion: Although large anterior cervical osteophyte is a rare cause of dysphagia and dyspnea, it should be checked and excluded especially in elderly patients. Adequate conservative therapy is a valid effective option; however, surgery in some of these patients may be simple, safe, and effective. (2019ESJ188)
{"title":"Dysphagia and Dyspnea Caused by Large Anterior Cervical Osteophyte","authors":"H. Elsobky, A. Zidan, A. Khalil, A. Elsobky","doi":"10.21608/esj.2020.8121.1099","DOIUrl":"https://doi.org/10.21608/esj.2020.8121.1099","url":null,"abstract":"Background Data: Unfortunately, large anterior cervical osteophytes are a forgotten cause of dysphagia and dyspnea. They can cause marked change in diet habits or interfere with patients’ daily activities and sleep without significant neck pain or radicular pain. Diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, degenerative changes, and prior trauma including surgery can cause cervical osteophytes. Conservative medical treatment and diet modification may be a useful option when treating these patients; however, surgery may be mandatory, in particular with sever progressive symptoms not responding to conservative measures with excellent results and accepted incidence of complications. Study Design: This is a retrospective clinical case study. Purpose: To highlight this uncommon cause of dyspnea and dysphagia and define the possible management strategies. Patients and Methods: This study was conducted in Mansoura University Hospital on nine patients presented with dysphagia, dyspnea, or both. The cause of their symptoms was large anterior cervical osteophytes. Six patients were males and 3 were females with their age ranged from 53 to 75 years. All patients were assessed by X-ray, CT, and MRI of the cervical spine and underwent fiber optic nasoendoscopy to assess posterior pharyngeal wall and other causes of upper airway obstruction. All patients had a trial of conservative measures including anti-inflammatory, antireflux medication, corticosteroids, diet modification, and consultations with specialists in rheumatology and speech and swallowing therapy. Results: Of the 9 patients, three patients improved on the above-mentioned conservative measures, and one patient who presented with stridor underwent urgent tracheostomy and refused further surgery. Five patients who failed conservative therapy for at least three months underwent surgical excision of their osteophytes through anterior cervical approach. Improvement of surgical group was satisfactory according to the Dysphagia Scoring System. Conclusion: Although large anterior cervical osteophyte is a rare cause of dysphagia and dyspnea, it should be checked and excluded especially in elderly patients. Adequate conservative therapy is a valid effective option; however, surgery in some of these patients may be simple, safe, and effective. (2019ESJ188)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41904291","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}
Pub Date : 2019-07-01DOI: 10.21608/esj.2019.12979.1102
A. Madkour, T. Metwally, M. Agamy
Abstract Background Data: Spondylolysis is the main identifiable cause of low back pain in children and adolescents. The fifth lumbar vertebra (L5) is the most common site for spondylolysis. The cause of spondylolysis in these patients is attributed to repetitive stress of the pars interarticularis with subsequent microfracture;it is believed that an inherited genetic pars weakness can make an individual more susceptible to spondylolysis.There are varieties of surgical techniques in the treatment of spondylolisthesis whether the traditional surgical fusion and instrumental fixation or the direct pars repair if no evident slippage, disc degeneration or canal stenosis. Purpose: Evaluations of the efficacy of pars repair as regard bony fusion, preservation of motion segment with no adjacent level disease. Patients and Methods: our study was conducted on10 patients with diagnosed isthmic spondylolysis.Three males and seven females were operated (between 2016- 2018) by direct pars repair using smile face shaped rod technique (V shaped rod technique) with insertion of iliac crest bone graft at the site of the defect bilaterally to enhance bony fusion at the fracture site. Age less than 30years, Weight less than 80kg, back pain not responding to conservative treatment. No slippage or less than 2mm, healthy disc space not degenerated, no disc herniation or canal stenosis, no previous disc operation, preserved sagittal balance and lumber lordosis. Results: All cases were assessed clinically and radiologically over one year to assess the improvement in back pain using RMQ and to assess bony fusion radiologically through PXR and CT lumbosacral spine. Good outcome was achieved in seven cases (70% of patients) with significant improvement in back pain and RMQ. Two cases (20% of patients) had fair outcome with occasional back pain occur with sports and strenuous activities. 1 case (10% of patients) had poor out come as the patient exposed to back trauma that lead to fracture of the L5 screw and operated again for traditional surgery with 4 screws, 2 rods and cage placemen. Par bony fusion was sound in all cases except one patient that was subjected to direct back trauma 3 months following surgery and had one screw fracture, that required redo surgery with formal fixation using 4 screws, 2 rods and intervertebral cage Conclusion: Direct pars repair can provide good functional outcomes in young adult patients with isthmic spondylolysis.
{"title":"Pars Repair in Isthmic Spondylolysis in the Young Adults","authors":"A. Madkour, T. Metwally, M. Agamy","doi":"10.21608/esj.2019.12979.1102","DOIUrl":"https://doi.org/10.21608/esj.2019.12979.1102","url":null,"abstract":"Abstract Background Data: Spondylolysis is the main identifiable cause of low back pain in children and adolescents. The fifth lumbar vertebra (L5) is the most common site for spondylolysis. The cause of spondylolysis in these patients is attributed to repetitive stress of the pars interarticularis with subsequent microfracture;it is believed that an inherited genetic pars weakness can make an individual more susceptible to spondylolysis.There are varieties of surgical techniques in the treatment of spondylolisthesis whether the traditional surgical fusion and instrumental fixation or the direct pars repair if no evident slippage, disc degeneration or canal stenosis. Purpose: Evaluations of the efficacy of pars repair as regard bony fusion, preservation of motion segment with no adjacent level disease. Patients and Methods: our study was conducted on10 patients with diagnosed isthmic spondylolysis.Three males and seven females were operated (between 2016- 2018) by direct pars repair using smile face shaped rod technique (V shaped rod technique) with insertion of iliac crest bone graft at the site of the defect bilaterally to enhance bony fusion at the fracture site. Age less than 30years, Weight less than 80kg, back pain not responding to conservative treatment. No slippage or less than 2mm, healthy disc space not degenerated, no disc herniation or canal stenosis, no previous disc operation, preserved sagittal balance and lumber lordosis. Results: All cases were assessed clinically and radiologically over one year to assess the improvement in back pain using RMQ and to assess bony fusion radiologically through PXR and CT lumbosacral spine. Good outcome was achieved in seven cases (70% of patients) with significant improvement in back pain and RMQ. Two cases (20% of patients) had fair outcome with occasional back pain occur with sports and strenuous activities. 1 case (10% of patients) had poor out come as the patient exposed to back trauma that lead to fracture of the L5 screw and operated again for traditional surgery with 4 screws, 2 rods and cage placemen. Par bony fusion was sound in all cases except one patient that was subjected to direct back trauma 3 months following surgery and had one screw fracture, that required redo surgery with formal fixation using 4 screws, 2 rods and intervertebral cage Conclusion: Direct pars repair can provide good functional outcomes in young adult patients with isthmic spondylolysis.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46491009","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}
Pub Date : 2019-07-01DOI: 10.21608/esj.2019.13664.1104
A. Khalil, Hossam Shata Ali, A. Zidan, Basem I. Awad
Background Data: Surgical management for high-grade spondylolisthesis is challenging and associated with high morbidity. There are many surgical techniques available for lumbosacral fixation and correction that differ in approaches and outcomes. The main concern during surgery is to decompress the neural element, correct focal kyphotic deformity, and restore or maintain global sagittal alignment. Purpose: The purpose of this study was to present a case series of patients with high-grade spondylolisthesis who were treated with reduction and fixation and compare the results to in situ fusion technique. Study Design: Retrospective observational study. Patients and Methods: We retrospectively reviewed patients with L5/S1 high-grade spondylolisthesis who underwent surgery at our institute in the period between March 2013 and March 2017. Patient’s demographic, preoperative, and postoperative data were collected. Taillard’s technique and Meyerding’s grade for spondylolisthesis were assessed for all cases. Additionally, we measured the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) pre- and postoperatively. The Bridwell grading system was used to assess the degree of radiographic fusion. Preoperative and postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Complication rates were collected during the follow-up period. Results: We included 16 cases in the current study. Patients were divided into two groups: reduction group includes nine patients, and in situ group includes seven. There was no significant difference in demographics or radiological data between groups. Moreover, operative data demonstrated comparable results between the two groups (P<0.05). Reduction group showed significant increase in L5 palsy compared to the in situ fusion group (0.037), although reduction showed more significant changes regarding correction of deformity (PT and SS). Both techniques were efficient in relieving pain and improving disability at 3-month and last follow-up visits (P<0.001). Conclusion: The present study showed that both reduction and in situ fusion techniques are effective surgical tools in improving clinical outcomes for patients with L5/S1 high-grade spondylolisthesis. Attempt of complete reduction carries a high risk of L5 nerve root injury. Partial reduction under complete L5 nerve root decompression and visualization is crucial in reducing risk of injury. However, reduction technique demonstrated superior deformity correction at the index level of spondylolisthesis. (2019ESJ181)
{"title":"Reduction versus Fusion In-Situ in High-Grade Spondylolisthesis","authors":"A. Khalil, Hossam Shata Ali, A. Zidan, Basem I. Awad","doi":"10.21608/esj.2019.13664.1104","DOIUrl":"https://doi.org/10.21608/esj.2019.13664.1104","url":null,"abstract":"Background Data: Surgical management for high-grade spondylolisthesis is challenging and associated with high morbidity. There are many surgical techniques available for lumbosacral fixation and correction that differ in approaches and outcomes. The main concern during surgery is to decompress the neural element, correct focal kyphotic deformity, and restore or maintain global sagittal alignment. Purpose: The purpose of this study was to present a case series of patients with high-grade spondylolisthesis who were treated with reduction and fixation and compare the results to in situ fusion technique. Study Design: Retrospective observational study. Patients and Methods: We retrospectively reviewed patients with L5/S1 high-grade spondylolisthesis who underwent surgery at our institute in the period between March 2013 and March 2017. Patient’s demographic, preoperative, and postoperative data were collected. Taillard’s technique and Meyerding’s grade for spondylolisthesis were assessed for all cases. Additionally, we measured the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) pre- and postoperatively. The Bridwell grading system was used to assess the degree of radiographic fusion. Preoperative and postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Complication rates were collected during the follow-up period. Results: We included 16 cases in the current study. Patients were divided into two groups: reduction group includes nine patients, and in situ group includes seven. There was no significant difference in demographics or radiological data between groups. Moreover, operative data demonstrated comparable results between the two groups (P<0.05). Reduction group showed significant increase in L5 palsy compared to the in situ fusion group (0.037), although reduction showed more significant changes regarding correction of deformity (PT and SS). Both techniques were efficient in relieving pain and improving disability at 3-month and last follow-up visits (P<0.001). Conclusion: The present study showed that both reduction and in situ fusion techniques are effective surgical tools in improving clinical outcomes for patients with L5/S1 high-grade spondylolisthesis. Attempt of complete reduction carries a high risk of L5 nerve root injury. Partial reduction under complete L5 nerve root decompression and visualization is crucial in reducing risk of injury. However, reduction technique demonstrated superior deformity correction at the index level of spondylolisthesis. (2019ESJ181)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47409118","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}
Pub Date : 2019-07-01DOI: 10.21608/esj.2020.20148.1115
M. El-Gaidi, M. Khattab
Background data: Atlanto-axial fixation, unlike subaxial spine, is still challenging due to complex topographical anatomy. Nowadays, atlas lateral mass screws and transpedicular axis screws fixation is a well-accepted technique for the management of atlantaoaxial instability due to their rigid fixation and higher fusion rate. However, in complex cases like basilar invagination, further reduction and proper bony alignment is needed. Study design: a retrospective descriptive clinical case series. Objective: The aim of this work was to assess the safety and efficiency of bilateral posterior atlanto-axial facet joint distraction and insertion of spacer in reducing complex cases of atlantoaxial instability. Patients and methods: Out of 17 patients with atlanto-axial instability, five patients underwent posterior fixation and atlanto-axial facet joint distraction and insertion of spacer for reduction of irreducible atlantoaxial dislocation. Clinical results were evaluated by using the criteria of Japanese Orthopaedic Association Scoring System for Cervical Myelopathy (JOA score). The surgical technique, results and morbidity and mortality were assessed. Results: There were 3 females and 2 males; the age ranged from 10y-50y). The cause of significant instability was trauma (2 patients), while each of the 3 other patients suffered from Down syndrome, rheumatoid arthritis and post tuberculous infection. All 5 patients had pyramidal tract compression manifestations. At the end of follow up (mean 18m), the average preoperative JOA score improved from 13.2 ± 1 SD to 15.9 ± 0.2 SD (p = 0.04) and the average recovery rate was 69% ± 12 % SD. Postoperative CT scans showed the mean atlantodens interval improved from 6.2mm ± 1.6 to 1.8mm ± 0.8 (p = 0.04), the mean clivus-canal angle increased from 119.8° ± 3.7° to 135.2° ± 7°(p = 0.04). The average extra time and blood loss of bilateral facet distraction and grafting was about 65m (p value = 0.004) and 72.5 ml respectively. There was no mortality, vertebral artery injury, CSF leak or construct failure. Conclusions: Bilateral posterior atlanto-axial facet joint distraction and placement of spacer is a safe and effective adjunct procedure for reduction of complex atlanto-axial instability.
{"title":"Role of Posterior Interfacetal Distraction and Grafting in Complex Atlanto-Axial Dislocation","authors":"M. El-Gaidi, M. Khattab","doi":"10.21608/esj.2020.20148.1115","DOIUrl":"https://doi.org/10.21608/esj.2020.20148.1115","url":null,"abstract":"Background data: Atlanto-axial fixation, unlike subaxial spine, is still challenging due to complex topographical anatomy. Nowadays, atlas lateral mass screws and transpedicular axis screws fixation is a well-accepted technique for the management of atlantaoaxial instability due to their rigid fixation and higher fusion rate. However, in complex cases like basilar invagination, further reduction and proper bony alignment is needed. Study design: a retrospective descriptive clinical case series. Objective: The aim of this work was to assess the safety and efficiency of bilateral posterior atlanto-axial facet joint distraction and insertion of spacer in reducing complex cases of atlantoaxial instability. Patients and methods: Out of 17 patients with atlanto-axial instability, five patients underwent posterior fixation and atlanto-axial facet joint distraction and insertion of spacer for reduction of irreducible atlantoaxial dislocation. Clinical results were evaluated by using the criteria of Japanese Orthopaedic Association Scoring System for Cervical Myelopathy (JOA score). The surgical technique, results and morbidity and mortality were assessed. Results: There were 3 females and 2 males; the age ranged from 10y-50y). The cause of significant instability was trauma (2 patients), while each of the 3 other patients suffered from Down syndrome, rheumatoid arthritis and post tuberculous infection. All 5 patients had pyramidal tract compression manifestations. At the end of follow up (mean 18m), the average preoperative JOA score improved from 13.2 ± 1 SD to 15.9 ± 0.2 SD (p = 0.04) and the average recovery rate was 69% ± 12 % SD. Postoperative CT scans showed the mean atlantodens interval improved from 6.2mm ± 1.6 to 1.8mm ± 0.8 (p = 0.04), the mean clivus-canal angle increased from 119.8° ± 3.7° to 135.2° ± 7°(p = 0.04). The average extra time and blood loss of bilateral facet distraction and grafting was about 65m (p value = 0.004) and 72.5 ml respectively. There was no mortality, vertebral artery injury, CSF leak or construct failure. Conclusions: Bilateral posterior atlanto-axial facet joint distraction and placement of spacer is a safe and effective adjunct procedure for reduction of complex atlanto-axial instability.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43879407","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}
Pub Date : 2019-07-01DOI: 10.21608/esj.2019.12243.1097
S. Samy, Yasser Elbanna, Islam Sorour
ABSTRACT BACKGROUND: Posterior C1-2 fusion techniques are the commonly used treatment for odontoid fracture. But this is usually associated with limitation in the cervical spine range of motion especially the rotational motion. Posterior C1-2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. OBJECTIVE: To assess the clinical and radiological outcome of the posterior C1-2 temporary fixation technique in the treatment of a new odontoid fracture. STUDY DESIGN: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. PATIENTS AND METHODS: 12 consecutive patients, suffering from Type II odontoid fracture. The age ranged between 15-43 years old with a mean age was 24±11.6 years old, eight were male and four females. All cases were post traumatic. Eight patients were dislocated and four cases were in place. Only two patients were suffering from partial neurologic deficit pre-operative. The second surgery was done after a mean 15.5 weeks from the first surgery. RESULTS: The radiological outcome showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°, using multi slice thin cuts CT scan. Significantly better functional outcomes were observed after the temporary-fixation removal using visual analog scale score (VAS) for neck pain (P=0.0033), neck stiffness and the patient satisfaction. CONCLUSION: Posterior atlanto-axial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved.
{"title":"Posterior C1-2 Temporary Fixation without Fusion for Recent Odontoid Fractures","authors":"S. Samy, Yasser Elbanna, Islam Sorour","doi":"10.21608/esj.2019.12243.1097","DOIUrl":"https://doi.org/10.21608/esj.2019.12243.1097","url":null,"abstract":"ABSTRACT BACKGROUND: Posterior C1-2 fusion techniques are the commonly used treatment for odontoid fracture. But this is usually associated with limitation in the cervical spine range of motion especially the rotational motion. Posterior C1-2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. OBJECTIVE: To assess the clinical and radiological outcome of the posterior C1-2 temporary fixation technique in the treatment of a new odontoid fracture. STUDY DESIGN: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. PATIENTS AND METHODS: 12 consecutive patients, suffering from Type II odontoid fracture. The age ranged between 15-43 years old with a mean age was 24±11.6 years old, eight were male and four females. All cases were post traumatic. Eight patients were dislocated and four cases were in place. Only two patients were suffering from partial neurologic deficit pre-operative. The second surgery was done after a mean 15.5 weeks from the first surgery. RESULTS: The radiological outcome showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°, using multi slice thin cuts CT scan. Significantly better functional outcomes were observed after the temporary-fixation removal using visual analog scale score (VAS) for neck pain (P=0.0033), neck stiffness and the patient satisfaction. CONCLUSION: Posterior atlanto-axial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48857009","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}
Pub Date : 2019-04-20DOI: 10.21608/ESJ.2019.5477.1069
A. F. Allam, T. A. Abotakia, Mahmoud Yasser Farghally
Background Data: Povidone-iodine is very effective broad spectrum antiseptic solution against different types of pathogens including methicillin-resistant Staphylococcus aureus and some strains of Enterococcus faecium based on the antiseptic properties of iodine. Purpose: To evaluate the effect of intraoperative 3.35 % povidone-iodine irrigation in lumbar spine fusion surgeries. Study Design: Retrospective clinical case study. Patients and Methods: 93 spine fusion surgeries in 2016 (Group I) and 112 fusion surgeries in 2017 (Group II). Both groups were retrospectively compared regarding infection rate, fusion rate, and Oswestry Disability Index (ODI) score. Group I had intraoperative saline irrigation and Group II was irrigated with 3.35 % povidone-iodine. Results: There were no reported infections in Group II. Two superficial and two deep wound infections were observed in Group I. Complete wound dehiscence was found in one patient with deep wound infection. The pathogens were methicillin-resistant Staphylococcus aureus in two cases, Klebsiella pneumonia in one case, and combination of methicillin-sensitive Staphylococcus aureus and Staphylococcus epidermidis in the last case. There was insignificant difference between the two groups in fusion rates and with no linear correlation relationship between povidone-iodine soaking time and the fusion rate in Group II. There was significant postoperative ODI improvement in the two groups relative to the preoperative scores with insignificant statistical difference when comparing this improvement of the two groups. Conclusion: Povidone-iodine 3.35% irrigation in lumbar spine fusion surgery is effective in decreasing postoperative infection with no negative influence on the fusion rate or clinical outcome. (2019ESJ177)
{"title":"Povidone-Iodine 3.35% Solution versus Normal Saline for Irrigation in Lumbar Fusion Surgery: A Retrospective Study","authors":"A. F. Allam, T. A. Abotakia, Mahmoud Yasser Farghally","doi":"10.21608/ESJ.2019.5477.1069","DOIUrl":"https://doi.org/10.21608/ESJ.2019.5477.1069","url":null,"abstract":"Background Data: Povidone-iodine is very effective broad spectrum antiseptic solution against different types of pathogens including methicillin-resistant Staphylococcus aureus and some strains of Enterococcus faecium based on the antiseptic properties of iodine. \u0000Purpose: To evaluate the effect of intraoperative 3.35 % povidone-iodine irrigation in lumbar spine fusion surgeries. \u0000Study Design: Retrospective clinical case study. \u0000Patients and Methods: 93 spine fusion surgeries in 2016 (Group I) and 112 fusion surgeries in 2017 (Group II). Both groups were retrospectively compared regarding infection rate, fusion rate, and Oswestry Disability Index (ODI) score. Group I had intraoperative saline irrigation and Group II was irrigated with 3.35 % povidone-iodine. \u0000Results: There were no reported infections in Group II. Two superficial and two deep wound infections were observed in Group I. Complete wound dehiscence was found in one patient with deep wound infection. The pathogens were methicillin-resistant Staphylococcus aureus in two cases, Klebsiella pneumonia in one case, and combination of methicillin-sensitive Staphylococcus aureus and Staphylococcus epidermidis in the last case. There was insignificant difference between the two groups in fusion rates and with no linear correlation relationship between povidone-iodine soaking time and the fusion rate in Group II. There was significant postoperative ODI improvement in the two groups relative to the preoperative scores with insignificant statistical difference when comparing this improvement of the two groups. \u0000Conclusion: Povidone-iodine 3.35% irrigation in lumbar spine fusion surgery is effective in decreasing postoperative infection with no negative influence on the fusion rate or clinical outcome. (2019ESJ177)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47438505","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}
Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.5491.1070
K. Ebrahim, A. Salem, S. Morad
{"title":"Radiofrequency Denervation for Management of Chronic Sacroiliac Joint Pain","authors":"K. Ebrahim, A. Salem, S. Morad","doi":"10.21608/ESJ.2019.5491.1070","DOIUrl":"https://doi.org/10.21608/ESJ.2019.5491.1070","url":null,"abstract":"","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44692011","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}
Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.6618.1085
Ahmed Rizk, Andy Ottenbacher
Background Data: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures. Purpose: To estimate the advantages and disadvantages of performing one- or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage. Study Design: Retrospective clinical cohort study. Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. Twenty-eight patients were females and 8 were males. Thirty patients had single-level TLIF and 6 double-level TLIF. The results of these patient series were retrospectively analyzed. The variables that were reviewed included blood transfusion, postoperative temperature, postoperative pain and the use of opiates during hospital stay, duration of surgery, duration of hospital stay, and incidence of postoperative complications such as neurological deficit, hematoma, postoperative wound infection, and revision surgery. Results: There was no postoperative allogenic blood transfusion; the patients did not develop postoperative neurological deficit; there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, which was treated conservatively with frequent dressing and antibiotics. Four patients (11.1%) developed transient postoperative fever. The mean pain score in the first 2 days after surgery assessed by the Visual Analogue Score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%). Conclusion: Performing one- or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the rate postoperative infection or hematoma formation. Additionally, none of our patients required postoperative blood transfusion. (2018ESJ168)
{"title":"One- or Two-Level Transforaminal Lumbar Interbody Fusion without Closed-Suction Wound Drainage","authors":"Ahmed Rizk, Andy Ottenbacher","doi":"10.21608/ESJ.2019.6618.1085","DOIUrl":"https://doi.org/10.21608/ESJ.2019.6618.1085","url":null,"abstract":"Background Data: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures. Purpose: To estimate the advantages and disadvantages of performing one- or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage. Study Design: Retrospective clinical cohort study. Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. Twenty-eight patients were females and 8 were males. Thirty patients had single-level TLIF and 6 double-level TLIF. The results of these patient series were retrospectively analyzed. The variables that were reviewed included blood transfusion, postoperative temperature, postoperative pain and the use of opiates during hospital stay, duration of surgery, duration of hospital stay, and incidence of postoperative complications such as neurological deficit, hematoma, postoperative wound infection, and revision surgery. Results: There was no postoperative allogenic blood transfusion; the patients did not develop postoperative neurological deficit; there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, which was treated conservatively with frequent dressing and antibiotics. Four patients (11.1%) developed transient postoperative fever. The mean pain score in the first 2 days after surgery assessed by the Visual Analogue Score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%). Conclusion: Performing one- or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the rate postoperative infection or hematoma formation. Additionally, none of our patients required postoperative blood transfusion. (2018ESJ168)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48361162","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}
Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.7149.1086
A. F. Toubar, M. E. Sawy
Background Data: Upper lumbar disc herniation involving D12/L1, L1/L2, and L2/L3 levels is less prevalent than lower lumbar discs. In terms of clinical characteristics and surgical managements, they are different from those at the lower levels of the lumbar spine. Spinal canals are narrower than those of the lower levels, which may compromise multiple spinal nerve roots or conus medullaris with higher complication rate with surgical intervention. Purpose: To investigate the clinical features and surgical outcomes of patients operated on for upper lumbar disc herniations. Study Design: Retrospective clinical cohort study. Patients and Methods: This study included 20 patients diagnosed with herniated disc at upper levels (T12-L1, L1-L2, and L2-L3). Patients were operated on during the period between June 2015 to March 2017. All patients were operated on via transfacet approach with pedicle screw fixation. Postoperative data including clinical and neurological outcomes and radiographic imaging have been collected. Postoperative follow-up evaluation included immediate postoperative medical records and a postoperative visit to the outpatient clinic until 18 months postoperatively. Patients’ outcomes were assessed using Visual Analogue Scale of radicular and back pain and Oswestry Disability Index (ODI) as functional score. Results: Over a mean follow-up period of 13±2.5 months, there was significant improvement in radicular pain (P = 0.0026) and back pain (P = 0.049) and myelopathy and statistically significant improvement in Oswestry Disability Index (ODI) (P = 0.0032) compared to the preoperative value. No postoperative complications were detected in this series. Conclusion: This approach offers a safe technique for decompression and stabilization at lower thoracic and upper lumbar region. (2019ESJ178)
{"title":"Herniated Disc at the Upper Lumbar Region: Surgical Technique and Clinical Outcomes","authors":"A. F. Toubar, M. E. Sawy","doi":"10.21608/ESJ.2019.7149.1086","DOIUrl":"https://doi.org/10.21608/ESJ.2019.7149.1086","url":null,"abstract":"Background Data: Upper lumbar disc herniation involving D12/L1, L1/L2, and L2/L3 levels is less prevalent than lower lumbar discs. In terms of clinical characteristics and surgical managements, they are different from those at the lower levels of the lumbar spine. Spinal canals are narrower than those of the lower levels, which may compromise multiple spinal nerve roots or conus medullaris with higher complication rate with surgical intervention. Purpose: To investigate the clinical features and surgical outcomes of patients operated on for upper lumbar disc herniations. Study Design: Retrospective clinical cohort study. Patients and Methods: This study included 20 patients diagnosed with herniated disc at upper levels (T12-L1, L1-L2, and L2-L3). Patients were operated on during the period between June 2015 to March 2017. All patients were operated on via transfacet approach with pedicle screw fixation. Postoperative data including clinical and neurological outcomes and radiographic imaging have been collected. Postoperative follow-up evaluation included immediate postoperative medical records and a postoperative visit to the outpatient clinic until 18 months postoperatively. Patients’ outcomes were assessed using Visual Analogue Scale of radicular and back pain and Oswestry Disability Index (ODI) as functional score. Results: Over a mean follow-up period of 13±2.5 months, there was significant improvement in radicular pain (P = 0.0026) and back pain (P = 0.049) and myelopathy and statistically significant improvement in Oswestry Disability Index (ODI) (P = 0.0032) compared to the preoperative value. No postoperative complications were detected in this series. Conclusion: This approach offers a safe technique for decompression and stabilization at lower thoracic and upper lumbar region. (2019ESJ178)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42913219","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}
Pub Date : 2019-04-01DOI: 10.21608/ESJ.2019.7091.1087
M. Kotb, A. Kotb, H. Anwer, M. Khattab
Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment towards more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoraco-lumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of literature. Patients and Methods: Thirty patients managed in the period from October 2012 to November 2016 for thoraco-lumbar burst fractures. Two patients’ groups were identified, group 1 underwent anterolateral fixation and included 15 patients whereas group 2 underwent posterior fixation and included 15 patients. Follow up was done at 3 months, 6 months and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise and kyphus deformity correction. Operative time, operative blood loss and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 cases. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared to the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where in posterior group all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in group 1 from 69.3% preoperatively to 15.62% postoperative whereas in group 2 it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, where in anterolateral group has been corrected from 19.42° to 17.57° and 20.9° respectively with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoraco-lumbar fractures. However anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction.
{"title":"Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review","authors":"M. Kotb, A. Kotb, H. Anwer, M. Khattab","doi":"10.21608/ESJ.2019.7091.1087","DOIUrl":"https://doi.org/10.21608/ESJ.2019.7091.1087","url":null,"abstract":"Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment towards more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoraco-lumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of literature. Patients and Methods: Thirty patients managed in the period from October 2012 to November 2016 for thoraco-lumbar burst fractures. Two patients’ groups were identified, group 1 underwent anterolateral fixation and included 15 patients whereas group 2 underwent posterior fixation and included 15 patients. Follow up was done at 3 months, 6 months and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise and kyphus deformity correction. Operative time, operative blood loss and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 cases. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared to the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where in posterior group all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in group 1 from 69.3% preoperatively to 15.62% postoperative whereas in group 2 it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, where in anterolateral group has been corrected from 19.42° to 17.57° and 20.9° respectively with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoraco-lumbar fractures. However anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42884519","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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