Evaluation of V.A.T.S.S. [video assisted thoracoscopic spine surgery]

Only recently, video-assisted thoracoscopy had been introduced in complex spine therapeutic procedures. Enhanced illumination, greater magnification allowing better visualization as well as less morbidity have put the procedure in challenge with traditional thoracotomy. Aiming to evaluate the procedure, 30 cases were included in this study. A prospective study was done on 14 cases having kyphoscoliosis deformities [8 paralytic and 6idiopathic] with average age of 14 years for whom anterior spinal release and fusion is indicated either for rigid deformity, exaggerated kyphosis or to avoid crankshaft phenomenon which might occur after posterior fusion alone. To compare the results with open thoracotomy, a group of 16 cases having same diagnosis and similar indications for which anterior spinal release and fusion was done through thoracotomy were studied retrospectively and was taken as a control group; making a total of 30 cases. Second stage posterior stabilization was done in all the cases in the two groups and the results were promising. VATSS alleviated incisional pain and postoperative respiratory difficulties, reduced blood loss and chest tube drainage, minimized ICU and hospital stay;which are problems usually faced with in thoracotomies. It was concluded that VATSS proved an effective, safe, accurate procedure that can be used in different thoracic spine indications with minimal complications

Success of intervertebral implants in posterior lumbar interbody fusion

The aim of this study was to evaluate the result of using the three types of posterior lumbar interbody fusion [PLIF]; the tricortical iliac bone graft, the carbon cage and the carbon ramp in managing cases of lumbar instability to evaluate the success of intervertebral implants in PLIF. A prospective study was done on 72 patients with average age of 38 years [46 males and 26 females] with lumbar instability due to different pathologies [infections, tumors and acute fractures were not included]. Cases were studied in three equal groups, each of 24. In group A, PLIF was done using autologous tricortical iliac bone graft, carbon cages were used in group B and carbon ramps in group C. For all, one level PLIF was done and was supplemented with rigid posterior stabilizing device to provide a solid biomechanical construct. Cases were followed up for an average period of 24 months. The results were compared clinically and radiologically with reference to fusion rate, time, intervertebral disc height, neural foraminal dimensions and degenerative changes in adjacent discs and facets

Prevention of post surgical peridural fibrosis using new anti-adhesion barrier gel

A prospective study was done on 40 patients [20 as controls and 20 for which Adcon-L was used]. All patients undergone first time unilateral, single level lumbar discectomy in a trial to evaluate the safety and effectiveness of Adcon-L as an adjunct to surgery to inhibit peridural scar and related symptoms following lumbar discectomy. Patients were followed up and evaluated six months postoperatively both clinically and by MRI. Radicular pain was recorded using a [0-10] standardized visual analog scale in which 0 = no pain and 10 = excuriating pain. Scar was scored on 0-4 scale on MRI, in which 0 = no scar and 4 = more than 75% of the MRI field containing scar. The results were promising as there was an increase in the number of patients with minimal or no scar by 250% increase. The number of patients having extensive scar was reduced in Adcon group by 83.3%. No major complications were encountered