Pub Date : 2011-03-01DOI: 10.1016/j.esas.2011.01.001
G.S. Middleton , J.H. Teacher , Donna D. Ohnmeiss DrMed (Special Deputy to the Editor-in-Chief)
A man was lifting a heavy plate from the floor to a bench, when he felt a “crack” in the small of his back. He suffered intense pain, and was unable to straighten himself. Paraplegia soon developed, and patient died sixteen days later, principally from the effects of bedsores and septic cystitis. The cause of the paraplegia was haemorrhage and softening in the lumbar enlargement of the spinal cord, and the cause of this was found in a mass of the pulp of an intervertebral disc which had been displaced into the vertebral canal.
{"title":"Injury of the spinal cord due to rupture of an intervertebral disk during muscular effort","authors":"G.S. Middleton , J.H. Teacher , Donna D. Ohnmeiss DrMed (Special Deputy to the Editor-in-Chief)","doi":"10.1016/j.esas.2011.01.001","DOIUrl":"https://doi.org/10.1016/j.esas.2011.01.001","url":null,"abstract":"<div><p>A man was lifting a heavy plate from the floor to a bench, when he felt a “crack” in the small of his back. He suffered intense pain, and was unable to straighten himself. Paraplegia soon developed, and patient died sixteen days later, principally from the effects of bedsores and septic cystitis. The cause of the paraplegia was haemorrhage and softening in the lumbar enlargement of the spinal cord, and the cause of this was found in a mass of the pulp of an intervertebral disc which had been displaced into the vertebral canal.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"5 1","pages":"Pages 26-27"},"PeriodicalIF":0.0,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2011.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137353174","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 : 2011-03-01DOI: 10.1016/j.esas.2010.11.001
Hiroshi Habunaga MD , Hiroaki Nakamura MD
Objectives
To describe a rare case of acute intracranial subdural hematoma as a cause of postoperative delirium and headache following cervical spine surgery.
Summary of Background Data
Headache is uncommon following spinal surgery, but can be observed in cases of accidental tearing of the dura during surgery. The causes of headache after surgery are thought to include dural tear and CSF leakage. On the other hand, intracranial subdural hematoma can be a cause of headache and cognitive dysfunction. However, only 4 cases as a postoperative complication of spinal surgery have been reported in the literature.
Methods
A 55-year-old man underwent re-explorative surgery due to postoperative hematoma causing hemiplegia following cervical laminoplasty. During this operation, accidental dural tear occurred and induced CSF leakage. On the following day, headache and delirium were noted. CSF leakage continued despite intraoperative repair of the dural laceration. Cranial CT at that time clearly demonstrated subdural hematoma.
Results
We reexplored the surgical site and attempted to stop the CSF leakage with meticulous suturing of the dural sac under microscopic observation. The intracranial subdural hematoma was carefully observed under consultation with a specialist neurosurgeon. Following this reexploration, the headache and delirium gradually improved, with spontaneous resolution of intracranial hematoma over a two-month period of observation.
Conclusions
We have reported a rare case of acute intracranial subdural hematoma caused by CSF leakage following cervical spine surgery. This report demonstrates the possibility of intracranial hematoma as a cause of postoperative cognitive dysfunction or headache, especially when accidental tearing of the dura has occurred in spinal surgery.
{"title":"Intracranial subdural hematoma as a cause of postoperative delirium and headache in cervical laminoplasty: A case report and review of the literature","authors":"Hiroshi Habunaga MD , Hiroaki Nakamura MD","doi":"10.1016/j.esas.2010.11.001","DOIUrl":"10.1016/j.esas.2010.11.001","url":null,"abstract":"<div><h3>Objectives</h3><p>To describe a rare case of acute intracranial subdural hematoma as a cause of postoperative delirium and headache following cervical spine surgery.</p></div><div><h3>Summary of Background Data</h3><p>Headache is uncommon following spinal surgery, but can be observed in cases of accidental tearing of the dura during surgery. The causes of headache after surgery are thought to include dural tear and CSF leakage. On the other hand, intracranial subdural hematoma can be a cause of headache and cognitive dysfunction. However, only 4 cases as a postoperative complication of spinal surgery have been reported in the literature.</p></div><div><h3>Methods</h3><p>A 55-year-old man underwent re-explorative surgery due to postoperative hematoma causing hemiplegia following cervical laminoplasty. During this operation, accidental dural tear occurred and induced CSF leakage. On the following day, headache and delirium were noted. CSF leakage continued despite intraoperative repair of the dural laceration. Cranial CT at that time clearly demonstrated subdural hematoma.</p></div><div><h3>Results</h3><p>We reexplored the surgical site and attempted to stop the CSF leakage with meticulous suturing of the dural sac under microscopic observation. The intracranial subdural hematoma was carefully observed under consultation with a specialist neurosurgeon. Following this reexploration, the headache and delirium gradually improved, with spontaneous resolution of intracranial hematoma over a two-month period of observation.</p></div><div><h3>Conclusions</h3><p>We have reported a rare case of acute intracranial subdural hematoma caused by CSF leakage following cervical spine surgery. This report demonstrates the possibility of intracranial hematoma as a cause of postoperative cognitive dysfunction or headache, especially when accidental tearing of the dura has occurred in spinal surgery.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"5 1","pages":"Pages 1-3"},"PeriodicalIF":0.0,"publicationDate":"2011-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33155952","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 : 2010-12-01DOI: 10.1016/j.esas.2010.09.003
Tuncay Kaner MD , Mehdi Sasani MD , Tunc Oktenoglu MD , Ahmet Levent Aydin MD , Ali Fahir Ozer MD
Background
Although some investigators believe that the rate of postoperative instability is low after lumbar spinal stenosis surgery, the majority believe that postoperative instability usually develops. Decompression alone and decompression with fusion have been widely used for years in the surgical treatment of lumbar spinal stenosis. Nevertheless, in recent years several biomechanical studies have shown that posterior dynamic transpedicular stabilization provides stabilization that is like the rigid stabilization systems of the spine. Recently, posterior transpedicular dynamic stabilization has been more commonly used as an alternative treatment option (rather than rigid stabilization with fusion) for the treatment of degenerative spines with chronic instability and for the prevention of possible instability after decompression in lumbar spinal stenosis surgery.
Methods
A total of 30 patients with degenerative lumbar spinal stenosis (19 women and 11 men) were included in the study group. The mean age was 67.3 years (range, 40–85 years). Along with lumbar decompression, a posterior dynamic transpedicular stabilization (dynamic transpedicular screw–rigid rod system) without fusion was performed in all patients. Clinical and radiologic results for patients were evaluated during follow-up visits at 3, 12, and 24 months postoperatively.
Results
The mean follow-up period was 42.93 months (range, 24–66 months). A clinical evaluation of patients showed that, compared with preoperative assessments, statistically significant improvements were observed in the Oswestry and visual analog scale scores in the last follow-up control. Compared with preoperative values, there were no statistically significant differences in radiologic evaluations, such as segmental lordosis angle (α) scores (P = .125) and intervertebral distance scores (P = .249). There were statistically significant differences between follow-up lumbar lordosis scores (P = .048). There were minor complications, including a subcutaneous wound infection in 2 cases, a dural tear in 2 cases, cerebrospinal fluid fistulas in 1 case, a urinary tract infection in 1 case, and urinary retention in 1 case. We observed L5 screw loosening in 1 of the 3-level decompression cases. No screw breakage was observed and no revision surgery was performed in any of these cases.
Conclusions
Posterior dynamic stabilization without fusion applied to lumbar decompression leads to better clinical and radiologic results in degenerative lumbar spinal stenosis. To avoid postoperative instability, especially in elderly patients who undergo degenerative lumbar spinal stenosis surgery with chronic instability, the application of decompression with posterior dynamic transpedicular stabilization is likely an important alternative surgical option to fusion, because it does not have fusion-related side effects, i
{"title":"Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic “semi-rigid” posterior system","authors":"Tuncay Kaner MD , Mehdi Sasani MD , Tunc Oktenoglu MD , Ahmet Levent Aydin MD , Ali Fahir Ozer MD","doi":"10.1016/j.esas.2010.09.003","DOIUrl":"10.1016/j.esas.2010.09.003","url":null,"abstract":"<div><h3>Background</h3><p>Although some investigators believe that the rate of postoperative instability is low after lumbar spinal stenosis surgery, the majority believe that postoperative instability usually develops. Decompression alone and decompression with fusion have been widely used for years in the surgical treatment of lumbar spinal stenosis. Nevertheless, in recent years several biomechanical studies have shown that posterior dynamic transpedicular stabilization provides stabilization that is like the rigid stabilization systems of the spine. Recently, posterior transpedicular dynamic stabilization has been more commonly used as an alternative treatment option (rather than rigid stabilization with fusion) for the treatment of degenerative spines with chronic instability and for the prevention of possible instability after decompression in lumbar spinal stenosis surgery.</p></div><div><h3>Methods</h3><p>A total of 30 patients with degenerative lumbar spinal stenosis (19 women and 11 men) were included in the study group. The mean age was 67.3 years (range, 40–85 years). Along with lumbar decompression, a posterior dynamic transpedicular stabilization (dynamic transpedicular screw–rigid rod system) without fusion was performed in all patients. Clinical and radiologic results for patients were evaluated during follow-up visits at 3, 12, and 24 months postoperatively.</p></div><div><h3>Results</h3><p>The mean follow-up period was 42.93 months (range, 24–66 months). A clinical evaluation of patients showed that, compared with preoperative assessments, statistically significant improvements were observed in the Oswestry and visual analog scale scores in the last follow-up control. Compared with preoperative values, there were no statistically significant differences in radiologic evaluations, such as segmental lordosis angle (α) scores (<em>P</em> = .125) and intervertebral distance scores (<em>P</em> = .249). There were statistically significant differences between follow-up lumbar lordosis scores (<em>P</em> = .048). There were minor complications, including a subcutaneous wound infection in 2 cases, a dural tear in 2 cases, cerebrospinal fluid fistulas in 1 case, a urinary tract infection in 1 case, and urinary retention in 1 case. We observed L5 screw loosening in 1 of the 3-level decompression cases. No screw breakage was observed and no revision surgery was performed in any of these cases.</p></div><div><h3>Conclusions</h3><p>Posterior dynamic stabilization without fusion applied to lumbar decompression leads to better clinical and radiologic results in degenerative lumbar spinal stenosis. To avoid postoperative instability, especially in elderly patients who undergo degenerative lumbar spinal stenosis surgery with chronic instability, the application of decompression with posterior dynamic transpedicular stabilization is likely an important alternative surgical option to fusion, because it does not have fusion-related side effects, i","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 4","pages":"Pages 99-106"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.09.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154954","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 : 2010-12-01DOI: 10.1016/j.esas.2010.07.002
Frank A. Buttacavoli MD, Rick B. Delamarter MD, Linda E.A. Kanim MA
Background
We sought to evaluate the difference between hospital service costs of 2 treatment options for patients diagnosed with 3-level degenerative disc disease (DDD) in the lumbar spine. In this retrospective analysis, itemized billing records of hospital stay for patients with 3-level DDD treated with artificial disc replacement (ADR) were compared with those treated with circumferential fusion (standard of care).
Methods
Sequential 3-level DDD patients treated with either ADR (ProDisc-L; Synthes, West Chester, Pennsylvania) or circumferential fusion during the period from January 2004 to October 2005 were included. Surgeries were performed at the same hospital for all patients. The ADR-treated patients were participating in the investigational device exemption clinical trial as part of the compassionate-use arm. Patients treated with fusion at the same institution during this same time interval were evaluated. Itemized billing records were collected at least 1 year after the index surgery. Costs according to hospital service categories were compared between ADR-treated and fusion-treated patients by use of analysis of variance and multivariate statistical techniques.
Results
There were 43 consecutive patients treated for 3-level DDD between January 2004 and October 2005. Of these, 21 underwent 3-level ADR and 22 had a 3-level fusion procedure. There was a mean of 3 fewer hospital days for patients treated with ADR (4.77 ± 1.11 days) than for those treated with fusion (8.00 ± 1.82 days) (P < .0001). The cost of hospital services for ADR-treated patients was 49% less excluding instrumentation costs and 54% less when accounting for instrumentation. The pattern of cost was similar when workers' compensation patients were analyzed separately.
Conclusions
ADR-treated 3-level patients benefited from significantly lower costs from their in-hospital stay compared with those treated by fusion. Hospital service costs were 49% (54% when instrumentation was included in the costs) less for ADR patients than for fusion patients.
背景:我们试图评估诊断为腰椎3级退变性椎间盘病(DDD)患者的两种治疗方案的医院服务费用差异。在这项回顾性分析中，我们比较了采用人工椎间盘置换术(ADR)治疗的3级DDD患者与采用周向融合术(标准治疗)治疗的患者的住院账单记录。方法序贯3级DDD患者分别采用ADR (ProDisc-L;包括2004年1月至2005年10月期间的Synthes, West Chester, Pennsylvania)或周向聚变。所有病人的手术都在同一家医院进行。不良反应治疗的患者参加了试验性器械豁免临床试验，作为同情使用组的一部分。在同一时间间隔在同一机构接受融合治疗的患者进行评估。在索引手术后至少1年收集分项计费记录。采用方差分析和多变量统计技术比较不良反应治疗和融合治疗患者按医院服务类别的费用。结果2004年1月至2005年10月共收治3级DDD患者43例。其中21例发生3级不良反应，22例行3级融合手术。不良反应组(4.77±1.11天)比融合组(8.00±1.82天)平均少住院3天(P <。)。不包括仪器费用，不良反应患者的医院服务费用减少了49%，考虑仪器费用时减少了54%。单独分析工伤赔偿患者的成本模式相似。结论与融合治疗相比，sadr治疗的3级患者住院费用明显降低。与融合患者相比，不良反应患者的医院服务成本低49%(当器械纳入成本时为54%)。
{"title":"Cost comparison of patients with 3-level artificial total lumbar disc replacements versus 360° fusion at 3 contiguous lumbar vertebral levels: an analysis of compassionate use at 1 site of the US investigational device exemption clinical trial","authors":"Frank A. Buttacavoli MD, Rick B. Delamarter MD, Linda E.A. Kanim MA","doi":"10.1016/j.esas.2010.07.002","DOIUrl":"10.1016/j.esas.2010.07.002","url":null,"abstract":"<div><h3>Background</h3><p>We sought to evaluate the difference between hospital service costs of 2 treatment options for patients diagnosed with 3-level degenerative disc disease (DDD) in the lumbar spine. In this retrospective analysis, itemized billing records of hospital stay for patients with 3-level DDD treated with artificial disc replacement (ADR) were compared with those treated with circumferential fusion (standard of care).</p></div><div><h3>Methods</h3><p>Sequential 3-level DDD patients treated with either ADR (ProDisc-L; Synthes, West Chester, Pennsylvania) or circumferential fusion during the period from January 2004 to October 2005 were included. Surgeries were performed at the same hospital for all patients. The ADR-treated patients were participating in the investigational device exemption clinical trial as part of the compassionate-use arm. Patients treated with fusion at the same institution during this same time interval were evaluated. Itemized billing records were collected at least 1 year after the index surgery. Costs according to hospital service categories were compared between ADR-treated and fusion-treated patients by use of analysis of variance and multivariate statistical techniques.</p></div><div><h3>Results</h3><p>There were 43 consecutive patients treated for 3-level DDD between January 2004 and October 2005. Of these, 21 underwent 3-level ADR and 22 had a 3-level fusion procedure. There was a mean of 3 fewer hospital days for patients treated with ADR (4.77 ± 1.11 days) than for those treated with fusion (8.00 ± 1.82 days) (<em>P</em> < .0001). The cost of hospital services for ADR-treated patients was 49% less excluding instrumentation costs and 54% less when accounting for instrumentation. The pattern of cost was similar when workers' compensation patients were analyzed separately.</p></div><div><h3>Conclusions</h3><p>ADR-treated 3-level patients benefited from significantly lower costs from their in-hospital stay compared with those treated by fusion. Hospital service costs were 49% (54% when instrumentation was included in the costs) less for ADR patients than for fusion patients.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 4","pages":"Pages 107-114"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154953","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 : 2010-12-01DOI: 10.1016/j.esas.2010.09.001
Rick B. Delamarter MD , Daniel Murrey MD , Michael E. Janssen DO , Jeffrey A. Goldstein MD , Jack Zigler MD , Bobby K.-B. Tay MD , Bruce Darden II MD
Background
Cervical total disk replacement (TDR) is intended to address pain and preserve motion between vertebral bodies in patients with symptomatic cervical disk disease. Two-year follow-up for the ProDisc-C (Synthes USA Products, LLC, West Chester, Pennsylvania) TDR clinical trial showed non-inferiority versus anterior cervical discectomy and fusion (ACDF), showing superiority in many clinical outcomes. We present the 4-year interim follow-up results.
Methods
Patients were randomized (1:1) to ProDisc-C (PDC-R) or ACDF. Patients were assessed preoperatively, and postoperatively at 6 weeks and 3, 6, 12, 18, 24, 36, and 48 months. After the randomized portion, continued access (CA) patients also underwent ProDisc-C implantation, with follow-up visits up to 24 months. Evaluations included Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain/satisfaction, and radiographic and physical/neurologic examinations.
Results
Randomized patients (103 PDC-R and 106 ACDF) and 136 CA patients were treated at 13 sites. VAS pain and NDI score improvements from baseline were significant for all patients (P < .0001) but did not differ among groups. VAS satisfaction was higher at all time points for PDC-R versus ACDF patients (P = .0499 at 48 months). The percentage of patients who responded yes to surgery again was 85.6% at 24 months and 88.9% at 48 months in the PDC-R group, 80.9% at 24 months and 81.0% at 48 months in the ACDF group, and 86.3% at 24 months in the CA group. Five PDC-R patients (48 months) and no CA patients (24 months) had index-level bridging bone. By 48 months, approximately 4-fold more ACDF patients required secondary surgery (3 of 103 PDC-R patients [2.9%] vs 12 of 106 ACDF patients [11.3%], P = .0292). Of these, 6 ACDF patients (5.6%) required procedures at adjacent levels. Three CA patients required secondary procedures (24 months).
Conclusions
Our 4-year data support that ProDisc-C TDR and ACDF are viable surgical options for symptomatic cervical disk disease. Although ACDF patients may be at higher risk for additional surgical intervention, patients in both groups show good clinical results at longer-term follow-up.
背景颈椎全椎间盘置换术(TDR)旨在解决症状性颈椎间盘疾病患者的疼痛并保持椎体之间的运动。对ProDisc-C (Synthes USA Products, LLC, West Chester, Pennsylvania) TDR临床试验的两年随访显示，与前路颈椎椎间盘切除术和融合(ACDF)相比，非劣效性，在许多临床结果上显示出优势。我们报告了4年的中期随访结果。方法将患者按1:1的比例随机分配到ProDisc-C (PDC-R)或ACDF组。术前和术后分别于6周、3、6、12、18、24、36和48个月对患者进行评估。在随机部分之后，继续访问(CA)患者也接受了ProDisc-C植入，随访长达24个月。评估包括颈部残疾指数(NDI)、疼痛/满意度视觉模拟量表(VAS)、放射学和物理/神经学检查。结果随机分组患者(103例PDC-R和106例ACDF)和136例CA患者在13个部位接受治疗。所有患者的VAS疼痛和NDI评分较基线均有显著改善(P <.0001)，但组间无差异。与ACDF患者相比，PDC-R患者在所有时间点的VAS满意度更高(48个月时P = 0.0499)。pd - r组再次手术的患者比例分别为:24个月时85.6%和48个月时88.9%，ACDF组24个月时80.9%和48个月时81.0%，CA组24个月时86.3%。5例PDC-R患者(48个月)和无CA患者(24个月)有指数水平桥接骨。到48个月时，大约4倍的ACDF患者需要二次手术(103例pd - r患者中有3例[2.9%]，106例ACDF患者中有12例[11.3%]，P = 0.0292)。其中，6例ACDF患者(5.6%)需要在邻近水平进行手术。3例CA患者需要二次手术(24个月)。结论4年数据支持ProDisc-C TDR和ACDF是治疗症状性颈椎间盘病的可行手术选择。虽然ACDF患者可能有更高的风险进行额外的手术干预，但两组患者在长期随访中均表现出良好的临床结果。
{"title":"Results at 24 months from the prospective, randomized, multicenter Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients","authors":"Rick B. Delamarter MD , Daniel Murrey MD , Michael E. Janssen DO , Jeffrey A. Goldstein MD , Jack Zigler MD , Bobby K.-B. Tay MD , Bruce Darden II MD","doi":"10.1016/j.esas.2010.09.001","DOIUrl":"10.1016/j.esas.2010.09.001","url":null,"abstract":"<div><h3>Background</h3><p>Cervical total disk replacement (TDR) is intended to address pain and preserve motion between vertebral bodies in patients with symptomatic cervical disk disease. Two-year follow-up for the ProDisc-C (Synthes USA Products, LLC, West Chester, Pennsylvania) TDR clinical trial showed non-inferiority versus anterior cervical discectomy and fusion (ACDF), showing superiority in many clinical outcomes. We present the 4-year interim follow-up results.</p></div><div><h3>Methods</h3><p>Patients were randomized (1:1) to ProDisc-C (PDC-R) or ACDF. Patients were assessed preoperatively, and postoperatively at 6 weeks and 3, 6, 12, 18, 24, 36, and 48 months. After the randomized portion, continued access (CA) patients also underwent ProDisc-C implantation, with follow-up visits up to 24 months. Evaluations included Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain/satisfaction, and radiographic and physical/neurologic examinations.</p></div><div><h3>Results</h3><p>Randomized patients (103 PDC-R and 106 ACDF) and 136 CA patients were treated at 13 sites. VAS pain and NDI score improvements from baseline were significant for all patients (<em>P</em> < .0001) but did not differ among groups. VAS satisfaction was higher at all time points for PDC-R versus ACDF patients (<em>P</em> = .0499 at 48 months). The percentage of patients who responded yes to surgery again was 85.6% at 24 months and 88.9% at 48 months in the PDC-R group, 80.9% at 24 months and 81.0% at 48 months in the ACDF group, and 86.3% at 24 months in the CA group. Five PDC-R patients (48 months) and no CA patients (24 months) had index-level bridging bone. By 48 months, approximately 4-fold more ACDF patients required secondary surgery (3 of 103 PDC-R patients [2.9%] vs 12 of 106 ACDF patients [11.3%], <em>P</em> = .0292). Of these, 6 ACDF patients (5.6%) required procedures at adjacent levels. Three CA patients required secondary procedures (24 months).</p></div><div><h3>Conclusions</h3><p>Our 4-year data support that ProDisc-C TDR and ACDF are viable surgical options for symptomatic cervical disk disease. Although ACDF patients may be at higher risk for additional surgical intervention, patients in both groups show good clinical results at longer-term follow-up.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 4","pages":"Pages 122-128"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154956","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 : 2010-12-01DOI: 10.1016/j.esas.2010.09.002
Jonathan E. Webb MD , Gilad J. Regev MD , Steven R. Garfin MD , Choll W. Kim MD, PhD
Background
Minimally invasive surgery (MIS) is dependent on intraoperative fluoroscopic imaging for visualization, which significantly increases exposure to radiation. Navigation-assisted fluoroscopy (NAV) can potentially decrease radiation exposure and improve the operating room environment by reducing the need for real-time fluoroscopy. The direct lateral interbody fusion (DLIF) procedure is a technique for MIS intervertebral lumbar and thoracic interbody fusions. This study assesses the use of navigation for the DLIF procedure in comparison to standard fluoroscopy (FLUORO), as well as the accuracy of the NAV MIS DLIF procedure.
Methods
Three fresh whole-body cadavers underwent multiple DLIF procedures at the T10-L5 levels via either NAV or FLUORO. Radiation exposure and surgical times were recorded and compared between groups. An additional cadaver was used to evaluate the accuracy of the NAV system for the DLIF procedure by measuring the deviation error as the surgeon worked further from the anterior superior iliac spine tracker.
Results
Approach, discectomy, and total fluoroscopy times for FLUORO were longer than NAV (P < .05). In contrast, the setup time was longer in NAV (P = .005). Cage insertion and total operating times were similar for both. Radiation exposure to the surgeon for NAV was significantly less than FLUORO (P < .05). Accuracy of the NAV system was within 1 mm for L2-5.
Conclusion
Navigation for the DLIF procedure is feasible. Accuracy for this procedure over the most common levels (L2-5) is likely sufficient for safe clinical application. Although initial setup times were longer with NAV, simultaneous anteroposterior and lateral imaging with the NAV system resulted in overall surgery times similar to FLUORO. Navigation minimizes fluoroscopic radiation exposure.
Clinical significance
Navigation for the DLIF procedure is accurate and decreases radiation exposure without increasing the overall surgical time.
背景微创手术(MIS)依赖于术中透视成像进行可视化，这大大增加了辐射暴露。导航辅助透视(NAV)可以通过减少对实时透视的需求，潜在地减少辐射暴露，改善手术室环境。直接外侧椎体间融合术(DLIF)是一种MIS椎体间腰椎和胸椎体间融合术。本研究评估了与标准透视(FLUORO)相比，导航在DLIF程序中的使用，以及NAV MIS DLIF程序的准确性。方法对3具新鲜尸体进行T10-L5水平的多次DLIF手术，分别采用NAV或FLUORO。记录两组间的辐射暴露和手术时间并进行比较。另一具尸体被用来评估NAV系统用于DLIF手术的准确性，通过测量当外科医生远离髂前上棘跟踪器时的偏差误差。结果氟组入路、椎间盘切除术和全透视时间均长于NAV组(P <. 05)。相比之下，NAV的设置时间更长(P = 0.005)。两者的笼插入时间和总手术时间相似。NAV对外科医生的辐射暴露明显小于氟化(P <. 05)。L2-5的NAV系统精度在1mm以内。结论DLIF手术导航是可行的。该方法在最常见的水平(L2-5)上的准确性可能足以安全的临床应用。虽然NAV的初始设置时间较长，但NAV系统同时进行正位和侧位成像的总体手术时间与FLUORO相似。导航最大限度地减少透视辐射暴露。临床意义:DLIF手术的导航准确，在不增加总手术时间的情况下减少了辐射暴露。
{"title":"Navigation-assisted fluoroscopy in minimally invasive direct lateral interbody fusion: a cadaveric study","authors":"Jonathan E. Webb MD , Gilad J. Regev MD , Steven R. Garfin MD , Choll W. Kim MD, PhD","doi":"10.1016/j.esas.2010.09.002","DOIUrl":"10.1016/j.esas.2010.09.002","url":null,"abstract":"<div><h3>Background</h3><p>Minimally invasive surgery (MIS) is dependent on intraoperative fluoroscopic imaging for visualization, which significantly increases exposure to radiation. Navigation-assisted fluoroscopy (NAV) can potentially decrease radiation exposure and improve the operating room environment by reducing the need for real-time fluoroscopy. The direct lateral interbody fusion (DLIF) procedure is a technique for MIS intervertebral lumbar and thoracic interbody fusions. This study assesses the use of navigation for the DLIF procedure in comparison to standard fluoroscopy (FLUORO), as well as the accuracy of the NAV MIS DLIF procedure.</p></div><div><h3>Methods</h3><p>Three fresh whole-body cadavers underwent multiple DLIF procedures at the T10-L5 levels via either NAV or FLUORO. Radiation exposure and surgical times were recorded and compared between groups. An additional cadaver was used to evaluate the accuracy of the NAV system for the DLIF procedure by measuring the deviation error as the surgeon worked further from the anterior superior iliac spine tracker.</p></div><div><h3>Results</h3><p>Approach, discectomy, and total fluoroscopy times for FLUORO were longer than NAV (<em>P</em> < .05). In contrast, the setup time was longer in NAV (<em>P</em> = .005). Cage insertion and total operating times were similar for both. Radiation exposure to the surgeon for NAV was significantly less than FLUORO (<em>P</em> < .05). Accuracy of the NAV system was within 1 mm for L2-5.</p></div><div><h3>Conclusion</h3><p>Navigation for the DLIF procedure is feasible. Accuracy for this procedure over the most common levels (L2-5) is likely sufficient for safe clinical application. Although initial setup times were longer with NAV, simultaneous anteroposterior and lateral imaging with the NAV system resulted in overall surgery times similar to FLUORO. Navigation minimizes fluoroscopic radiation exposure.</p></div><div><h3>Clinical significance</h3><p>Navigation for the DLIF procedure is accurate and decreases radiation exposure without increasing the overall surgical time.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 4","pages":"Pages 115-121"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154955","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 : 2010-12-01DOI: 10.1016/j.esas.2010.10.001
L.P. Nolte, L.J. Zamorano, Z. Jiang, Q. Wang, F. Langlotz, U. Berlemann
Study Design
A computer-assisted system allowing precise preoperative planning and real-time intraoperative image localization of surgical instruments is tested in a laboratory setup.
Objectives
The purpose of this study is to assess the applicability, functionality, and accuracy of this transpedicular spinal fixation technique.
Summary of Background Data
Most techniques in transpedicular spinal fixation rely on the identification of predefined targets with the help of anatomic landmarks and on the intraoperative use of image intensifiers. Various studies report considerable screw misplacement rates which may lead to serious clinical sequelae such as permanent nerve damage.
Methods
The proposed system was tested in an in vitro setup drilling 20 pedicle pilot holes in lumbar vertebrae. The accuracy was assessed using precision cuts through the pedicles and simulation of a 6-mm pedicle screw insertion.
Results
An ideal screw position was found in 70 of 77 cuts, and in no case was an injury to the pedicular cortex observed.
Conclusions
The presented technique provides a safe, accurate, and flexible basis for transpedicular screw placement in the spine. This approach should be further evaluated in clinical applications.
{"title":"Image-guided insertion of transpedicular screws. A laboratory set-up","authors":"L.P. Nolte, L.J. Zamorano, Z. Jiang, Q. Wang, F. Langlotz, U. Berlemann","doi":"10.1016/j.esas.2010.10.001","DOIUrl":"https://doi.org/10.1016/j.esas.2010.10.001","url":null,"abstract":"<div><h3>Study Design</h3><p>A computer-assisted system allowing precise preoperative planning and real-time intraoperative image localization of surgical instruments is tested in a laboratory setup.</p></div><div><h3>Objectives</h3><p>The purpose of this study is to assess the applicability, functionality, and accuracy of this transpedicular spinal fixation technique.</p></div><div><h3>Summary of Background Data</h3><p>Most techniques in transpedicular spinal fixation rely on the identification of predefined targets with the help of anatomic landmarks and on the intraoperative use of image intensifiers. Various studies report considerable screw misplacement rates which may lead to serious clinical sequelae such as permanent nerve damage.</p></div><div><h3>Methods</h3><p>The proposed system was tested in an in vitro setup drilling 20 pedicle pilot holes in lumbar vertebrae. The accuracy was assessed using precision cuts through the pedicles and simulation of a 6-mm pedicle screw insertion.</p></div><div><h3>Results</h3><p>An ideal screw position was found in 70 of 77 cuts, and in no case was an injury to the pedicular cortex observed.</p></div><div><h3>Conclusions</h3><p>The presented technique provides a safe, accurate, and flexible basis for transpedicular screw placement in the spine. This approach should be further evaluated in clinical applications.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 4","pages":"Pages 129-130"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137161461","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 : 2010-09-01DOI: 10.1016/j.esas.2010.01.005
Svante Berg MD, PhD , Hans Tropp MD, PhD
Background
Difficulties in performing randomized controlled trials (RCTs) to evaluate new treatment options are increasing. Higher costs and patient unwillingness are the main obstacles. A spinal surgery register has been in use in Sweden for 11 years. Our aim was to determine whether this register can provide the same information as an RCT and whether register data compare favorably with RCT data, making RCTs unnecessary. If not the case, was patient selection or follow-up frequency the cause of any differences?
Materials and methods
We compared baseline data and outcome, retrieved from our register, between 2 surgical groups, total disc replacement (TDR) and fusion at 1 or 2 levels, performed for degenerative disc disease. One hundred fifty-two patients were part of an RCT, whereas four hundred fifty-five patients had been treated according to an active decision. These 2 subgroups were the subjects for comparison.
Results
The 2 subgroups were not similar at baseline. Patients who were fused in the non-RCT subgroup were older, had a higher Oswestry Disability Index, and were more frequently smokers than the other patients. The outcome for the non-RCT group showed larger differences in favor of TDR than the RCT did. The nonresponders in the non-RCT group showed worse life quality and disability at baseline, and patients who answered the 1-year follow-up questionnaire but not the 2-year follow-up questionnaire had an inferior clinical result compared with the other patients at 1 year.
Conclusion
Data from our register showed results similar to the RCT, but a register cannot fully replace an RCT study when evaluating a new treatment option if the RCT has narrower selection than just the diagnosis. In this RCT comparing TDR with posterior fusion, the normal exclusion criteria for TDR were used. These were not registered, so the register could not prevent a possible selection bias, which might also be caused by the nonresponders.
{"title":"Results from a randomized controlled study between total disc replacement and fusion compared with results from a spine register","authors":"Svante Berg MD, PhD , Hans Tropp MD, PhD","doi":"10.1016/j.esas.2010.01.005","DOIUrl":"10.1016/j.esas.2010.01.005","url":null,"abstract":"<div><h3>Background</h3><p>Difficulties in performing randomized controlled trials (RCTs) to evaluate new treatment options are increasing. Higher costs and patient unwillingness are the main obstacles. A spinal surgery register has been in use in Sweden for 11 years. Our aim was to determine whether this register can provide the same information as an RCT and whether register data compare favorably with RCT data, making RCTs unnecessary. If not the case, was patient selection or follow-up frequency the cause of any differences?</p></div><div><h3>Materials and methods</h3><p>We compared baseline data and outcome, retrieved from our register, between 2 surgical groups, total disc replacement (TDR) and fusion at 1 or 2 levels, performed for degenerative disc disease. One hundred fifty-two patients were part of an RCT, whereas four hundred fifty-five patients had been treated according to an active decision. These 2 subgroups were the subjects for comparison.</p></div><div><h3>Results</h3><p>The 2 subgroups were not similar at baseline. Patients who were fused in the non-RCT subgroup were older, had a higher Oswestry Disability Index, and were more frequently smokers than the other patients. The outcome for the non-RCT group showed larger differences in favor of TDR than the RCT did. The nonresponders in the non-RCT group showed worse life quality and disability at baseline, and patients who answered the 1-year follow-up questionnaire but not the 2-year follow-up questionnaire had an inferior clinical result compared with the other patients at 1 year.</p></div><div><h3>Conclusion</h3><p>Data from our register showed results similar to the RCT, but a register cannot fully replace an RCT study when evaluating a new treatment option if the RCT has narrower selection than just the diagnosis. In this RCT comparing TDR with posterior fusion, the normal exclusion criteria for TDR were used. These were not registered, so the register could not prevent a possible selection bias, which might also be caused by the nonresponders.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 3","pages":"Pages 68-74"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.01.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154949","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 : 2010-09-01DOI: 10.1016/j.esas.2010.07.001
Paul A. Anderson MD
{"title":"Meta-analysis","authors":"Paul A. Anderson MD","doi":"10.1016/j.esas.2010.07.001","DOIUrl":"10.1016/j.esas.2010.07.001","url":null,"abstract":"","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 3","pages":"Page 67"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33036439","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 : 2010-09-01DOI: 10.1016/j.esas.2010.01.004
Kenneth Vaz BS, Kushagra Verma MS, Themistocles Protopsaltis MD, Frank Schwab MD, Baron Lonner MD, Thomas Errico MD
Background
Iliac crest harvest has been considered the “gold standard” at producing successful arthrodesis of the lumbar spine but is also associated with many donor-site morbidities. Many alternatives have been used to avoid iliac crest harvest, including autologous bone from other donor sites, allogeneic bone, ceramics, and recombinant human bone morphogenetic proteins (rhBMPs). This review will highlight the properties and preparations of these graft types and their potential complications and reported clinical efficacy.
Methods
A Medline search was conducted via PubMed by use of the following terms in various combinations: lumbar fusion, freeze-dried allograft, fresh-frozen allograft, autograft, iliac crest, demineralized bone matrix, rhBMP-2, rhBMP-7, scoliosis, bone marrow aspirate, HEALOS, coralline hydroxyapatite, beta tricalcium phosphate, synthetic, ceramics, spinal fusion, PLF, PLIF, ALIF, and TLIF. Only articles written in English were assessed for appropriate material. Related articles were also assessed depending on the content of articles found in the original literature search.
Conclusions
Although iliac crest remains the gold standard, reported success with alternative approaches, especially in combination, has shown promise. Stronger evidence with limited sources of potential bias is necessary to provide a clear picture of their clinical efficacy.
{"title":"Bone grafting options for lumbar spine surgery: a review examining clinical efficacy and complications","authors":"Kenneth Vaz BS, Kushagra Verma MS, Themistocles Protopsaltis MD, Frank Schwab MD, Baron Lonner MD, Thomas Errico MD","doi":"10.1016/j.esas.2010.01.004","DOIUrl":"10.1016/j.esas.2010.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Iliac crest harvest has been considered the “gold standard” at producing successful arthrodesis of the lumbar spine but is also associated with many donor-site morbidities. Many alternatives have been used to avoid iliac crest harvest, including autologous bone from other donor sites, allogeneic bone, ceramics, and recombinant human bone morphogenetic proteins (rhBMPs). This review will highlight the properties and preparations of these graft types and their potential complications and reported clinical efficacy.</p></div><div><h3>Methods</h3><p>A Medline search was conducted via PubMed by use of the following terms in various combinations: lumbar fusion, freeze-dried allograft, fresh-frozen allograft, autograft, iliac crest, demineralized bone matrix, rhBMP-2, rhBMP-7, scoliosis, bone marrow aspirate, HEALOS, coralline hydroxyapatite, beta tricalcium phosphate, synthetic, ceramics, spinal fusion, PLF, PLIF, ALIF, and TLIF. Only articles written in English were assessed for appropriate material. Related articles were also assessed depending on the content of articles found in the original literature search.</p></div><div><h3>Conclusions</h3><p>Although iliac crest remains the gold standard, reported success with alternative approaches, especially in combination, has shown promise. Stronger evidence with limited sources of potential bias is necessary to provide a clear picture of their clinical efficacy.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"4 3","pages":"Pages 75-86"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2010.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33154951","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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