ABSTRACT
STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.
Subject(s)
Humans , Cohort Studies , Follow-Up Studies , Fractures, Spontaneous , Life Expectancy , Neoplasm Metastasis , Pain, Postoperative , Palliative Care , Retrospective Studies , Spine , Traumatology , Visual Analog ScaleABSTRACT
Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.
Subject(s)
Decompression , SpineABSTRACT
Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.
Subject(s)
Decompression , SpineABSTRACT
OBJECTIVE: Surgical treatment of lumbosacral foraminal stenosis requires an understanding of the anatomy of the lumbosacral area in individual patients. Unilateral facetectomy has been used to completely decompress entrapment of the L5 nerve root, followed in some patients by posterior lumbar interbody fusion (PLIF) with stand-alone cages. METHODS: We assessed 34 patients with lumbosacral foraminal stenosis who were treated with unilateral facetectomy and PLIF using stand-alone cages in our center from January 2004 to September 2007. All the patients underwent follow-up X-rays, including a dynamic view, at 3, 6, 12, 24 months, and computed tomography (CT) at 24 months postoperatively. Clinical outcomes were analyzed with the mean numeric rating scale (NRS), Oswestry Disability Index (ODI) and Odom's criteria. Radiological outcomes were assessed with change of disc height, defined as the average of anterior, middle, and posterior height in plain X-rays. In addition, lumbosacral fusion was also assessed with dynamic X-ray and CT. RESULTS: Mean NRS score, which was 9.29 prior to surgery, was 1.5 at 18 months after surgery. The decrease in NRS was statistically significant. Excellent and good groups with regard to Odom's criteria were 31 cases (91%) and three cases (9%) were fair. Pre-operative mean ODI of 28.4 decreased to 14.2 at post-operative 24 months. In 30 patients, a bone bridge on CT scan was identified. The change in disc height was 8.11 mm, 10.02 mm and 9.63 mm preoperatively, immediate postoperatively and at 24 months after surgery, respectively. CONCLUSION: In the treatment of lumbosacral foraminal stenosis, unilateral facetectomy and interbody fusion using expandable stand-alone cages may be considered as one treatment option to maintain post-operative alignment and to obtain satisfactory clinical outcomes.
Subject(s)
Humans , Constriction, Pathologic , Follow-Up StudiesABSTRACT
Accepted methods of treatment of lumbar burst fractures include conservative therapy, posterior reduction and instrumentation, and anterior decompression and instrumentation. Surgery aims at the correction of the kyphotic deformity and at the decompression of the spinal cord thereby reducing pain and allowing early patient mobilization. Posterior-only procedures usually rely on ligamentotaxis or manual tamping of bone fragments for decompression of the spinal canal. Transpedicular corpectomy allow for circumferential surgery through a single posterior approach. The authors use an expandable cage to restore the normal spinal curvature and to prevent the kyphotic deformity.
Subject(s)
Humans , Congenital Abnormalities , Decompression , Spinal Canal , Spinal Cord , Spinal CurvaturesABSTRACT
OBJECTIVE: This multi-center clinical study was designed to determine the long-term results of patients who received a one-level posterior lumbar interbody fusion with expandable cage (Tyche(R) cage) for degenerative spinal diseases during the same period in each hospital. METHODS: Fifty-seven patients with low back pain who had a one-level posterior lumbar interbody fusion using a newly designed expandable cage were enrolled in this study at five centers from June 2003 to December 2004 and followed up for 24 months. Pain improvement was checked with a Visual Analogue Scale (VAS) and their disability was evaluated with the Oswestry Disability Index. Radiographs were obtained before and after surgery. At the final follow-up, dynamic stability, quality of bone fusion, interveretebral disc height, and lumbar lordosis were assessed. In some cases, a lumbar computed tomography scan was also obtained. RESULTS: The mean VAS score of back pain was improved from 6.44 points preoperatively to 0.44 at the final visit and the score of sciatica was reduced from 4.84 to 0.26. Also, the Oswestry Disability Index was improved from 32.62 points preoperatively to 18.25 at the final visit. The fusion rate was 92.5%. Intervertebral disc height, recorded as 9.94+/-2.69 mm before surgery was increased to 12.23+/-3.31 mm at postoperative 1 month and was stabilized at 11.43+/-2.23 mm on final visit. The segmental angle of lordosis was changed significantly from 3.54+/-3.70 degrees before surgery to 6.37+/-3.97 degrees by 24 months postoperative, and total lumbar lordosis was 20.37+/-11.30 degrees preoperatively and 24.71+/-11.70 degrees at 24 months postoperative. CONCLUSION: The re have been no special complications regarding the expandable cage during the follow-up period and the results of this study demonstrates a high fusion rate and clinical success.
Subject(s)
Animals , Humans , Back Pain , Follow-Up Studies , Intervertebral Disc , Lordosis , Low Back Pain , Sciatica , Spinal DiseasesABSTRACT
Complete vertebral tumor resection is important in order to prevent local recurrence. Among the available techniques for total spondylectomy, the total en bloc spondylectomy has been accepted as the most sophisticated one. After a total en bloc spondylectomy, anterior and posterior column reconstruction is mandatory in order to achieve stability. We experienced the usefulness of an expandable cage for anterior column reconstruction especially in this surgery. The chance of cutting the nerve root and damaging the spinal cord is minimized because the size of the expandable cage is initially small enough to be inserted into the anterior column. The technical details of total vertebral body replacement with an expandable cage after an en bloc lumbar spondylectomy are described herein.
Subject(s)
Recurrence , Spinal CordABSTRACT
OBJECTIVE: Expandable cage used for spinal reconstruction after corpectomy has several advantages over nonexpendable cages. Here we present our clinical experience with the use of this cage after anterior column corpectomy with an average of one year follow up. METHODS: Ten patients underwent expandable cage reconstruction of the anterior column after single-level or multilevel corpectomy for various cervical spinal disorders. Anterior plating with or without additional posterior instrumentation were performed in all patients. Functional outcomes, complications, and radiographic outcomes were determined. RESULTS: There was no cage-related complication. Functionally, neurological examination revealed improvement in 7 of 10 patients and no patient had neurological deterioration after the surgery. Immediate stability was achieved and maintained throughout the period of follow-up. There was minimal subsidence (<2mm) noticeable in three of the cases that underwent a two-level corpectomy. Subsidence was noted in osteoporotic patients and patients undergoing multi-level corpectomies. Average pre-operative kyphotic angle was 9 degrees. This was corrected to an average of 5.4 degrees in lordosis postoperatively. CONCLUSION: In conclusion, expandable cages are safe and effective devices for vertebral body replacement after cervical corpectomy when used in combination with anterior plating with or without additional posterior stabilization. The advantages of using expandable cages include its ability to easily accommodate itself into the corpectomy defect, its ability to tightly purchase into the endplates after expansion and thus minimizing the potential for migration, and finally, its ability to correct kyphosis deformity via its in vivo expansion properties.
Subject(s)
Animals , Humans , Congenital Abnormalities , Follow-Up Studies , Kyphosis , Lordosis , Neurologic Examination , Spinal Fusion , SpineABSTRACT
OBJECTIVE: The authors performed lumbar arthrodesis with expandable cage at L3-4 to L5-S1 intervertebral space for one year and report the analysis of the factors influencing the successful results. METHODS: The authors included thirty-five patients whose bony fusion had been watched over the 12 month after a posterior interbody fusion procedure with one-level expandable cage. All patients were classified into group A(satisfactory results) and group B(unsatisfactory results) according to their answers to comprehensive low back questionnairies. The intervertebral disc height, segmental lordosis and total lumbar lordosis in the standing neutral lateral radiography were checked and the comparison in the changes of this radiological profiles before and after the surgery was done. RESULTS: Seventeen cases(48.6%) of "excellent" results, and 14 cases(40.0%) of "good" results were included in Group A. In group B, 2 cases(5.7%) of "fair" results and 2 cases(5.7%) of "poor" results were included. Over twelve months after the operation, the mean intervertebral disc height and segmental lordotic angle in group A significantly increased, but those in group B did not significantly increase; however, the improvement of total lumbar lordotic angle could not be observed on both groups. CONCLUSION: The results indicate that the recovery of both intervertebral disc height and segmental lordosis is absolutely essential in order to get a successful result in addition to the solid arthrodesis. However, significant influences of one-level segmental lordotic improvement on the total lumbar lordosis can not be observed after the expandable cage fusion in the lower lumbar spine.