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1.
Chinese Acupuncture & Moxibustion ; (12): 743-746, 2023.
Article in Chinese | WPRIM | ID: wpr-980789

ABSTRACT

OBJECTIVE@#To observe the effect of buccal acupuncture on pain after lumbar spinal fusion.@*METHODS@#Sixty patients undergoing lumbar spinal fusion were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 1 case was eliminated). The patients in the control group were treated with routine anesthesia. On the basis of the control group, the patients in the observation group were treated with buccal acupuncture at bilateral back point, waist point, and sacral point for 30 min per treatment. The first acupuncture was given before anesthesia induction, and then once a day postoperation for two days, totally 3 treatments. The dosage of sufentanil, the number of remedial analgesia, and the incidence of nausea and vomiting within 48 h after surgery were compared between the two groups; rest and motion visual analogue scale (VAS) scores at 2 (T1), 8 (T2), 12 (T3), 24 (T4), and 48 (T5) h after surgery were observed; the quality of recovery-15 scale (QoR-15) at 24 and 48 h after surgery were evaluated.@*RESULTS@#The dosage of sufentanil and the number of remedial analgesia within 48 h after surgery in the observation group were lower than those in the control group (P<0.01). There was no significant statistically difference in rest and motion VAS scores between the two groups in T1, T2, T3, T4 and T5 (P>0.05). The QoR-15 scores in the observation group at 24 and 48 h after surgery were higher than those in the control group (P<0.01). The incidence of nausea in the observation group was lower than that in the control group (P<0.05).@*CONCLUSION@#Buccal acupuncture could reduce the amount of postoperative analgesic drugs of patients after lumbar spinal fusion, and promote early postoperative recovery.


Subject(s)
Humans , Spinal Fusion/adverse effects , Sufentanil , Acupuncture Therapy , Pain Management , Pain , Nausea
2.
China Journal of Orthopaedics and Traumatology ; (12): 554-558, 2023.
Article in Chinese | WPRIM | ID: wpr-981731

ABSTRACT

OBJECTIVE@#To explore the relationship between spinous process deviation and lumbar disc herniation in young patients.@*METHODS@#From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded.@*RESULTS@#The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05).@*CONCLUSION@#Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.


Subject(s)
Middle Aged , Humans , Intervertebral Disc Displacement/complications , Vertebral Body , Spinal Diseases , Spinal Fusion/adverse effects , Lumbar Vertebrae/diagnostic imaging , Intervertebral Disc Degeneration/etiology
3.
China Journal of Orthopaedics and Traumatology ; (12): 428-431, 2023.
Article in Chinese | WPRIM | ID: wpr-981709

ABSTRACT

OBJECTIVE@#To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.@*METHODS@#A retrospective analysis was performed on 138 patients who underwent L5S1 posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L4,5 facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L4,5 intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.@*RESULTS@#There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L4,5 intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (P<0.001), with no significant difference between the groups(P>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (P<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (P<0.0167, Bonferroni correction).@*CONCLUSION@#Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.


Subject(s)
Humans , Intervertebral Disc Degeneration/surgery , Zygapophyseal Joint/surgery , Retrospective Studies , Spinal Fusion/adverse effects , Lumbar Vertebrae/surgery , Spondylosis , Treatment Outcome
4.
Rev. chil. anest ; 50(3): 272-279, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1525587

ABSTRACT

INTRODUCTION: Acute postoperative pain is a complex problem given the pathophysiological characteristics, increasing health costs and complications and hindering recovery[1],[2]. Spinal arthrodesis is one of the most painful surgical procedures, presenting intense and disabling pain[3],[4]. Multimodal analgesia has been the tool with the best results, based on opioids; however, the combined use of drugs and dependence on opiates are important consequences. Therefore, the analgesic behavior during the use of subanesthetic doses of ketamine is described in the patients undergoing this procedure. METHODOLOGY: A prospective case series study was conducted from January-December 2019, with patients undergoing spinal arthrodesis who met the inclusion criteria, at the Hernando Moncaleano Perdomo University Hospital, Neiva. A univariate statistical analysis of all the variables is performed, with a joint interpretation of the results. RESULTS: A total of 17 patients underwent surgery, one of whom was excluded due to complications related to the surgical material. 88% of the patients showed evaluations of mild or absent pain in at least 4 times, with a number of morphine rescues in 24 hours of 1-2 per patient and patient ambulation in 90% on the first day. CONCLUSIONS. Postoperative spinal arthrodesis patients receiving intravenous ketamine infusion-based analgesia at subanesthetic doses showed mild or absent pain scores at almost all times.


INTRODUCCIÓN: El dolor agudo postoperatorio es un problema complejo dada las características fisiopatológicas, aumentando los costos en salud y las complicaciones y dificultando la recuperación[1],[2]. La artrodesis de columna, es uno de los procedimientos quirúrgicos más dolorosos, presentando un dolor intenso e incapacitante[3],[4]. La analgesia multimodal ha sido la herramienta con mejores resultados, tomando como base los opioides; sin embargo, el uso combinado de fármacos y la dependencia a opiáceos son consecuencias importantes. Por lo anterior, se describe el comportamiento analgésico durante el uso de dosis subanestésicas de ketamina en los pacientes llevados a dicho procedimiento. METODOLOGÍA: Se realiza un estudio tipo serie de casos, prospectivo de enero-diciembre de 2019, con los pacientes llevados a artrodesis de columna que cumplieron con los criterios de inclusión en el Hospital Universitario Hernando Moncaleano Perdomo, Neiva. Se realiza un análisis estadístico univariado de la totalidad de las variables, con una interpretación conjunta de los resultados. RESULTADOS: Se intervinieron un total de 17 pacientes, uno de los cuales fue excluido por complicaciones relacionadas con el material quirúrgico. El 88% de los pacientes mostraron valoraciones de dolor leve o ausente en al menos 4 tiempos, con número de rescates de morfina en 24 h de 1-2 por paciente y deambulación de los pacientes en el 90% en el primer día. CONCLUSIONES: Los pacientes posoperatorios de artrodesis de columna que recibieron analgesia basada en infusión endovenosa de ketamina a dosis subanestésicas mostraron valoraciones de dolor leve o ausente, en casi todos los tiempos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pain, Postoperative/therapy , Spinal Diseases/surgery , Spinal Fusion/adverse effects , Analgesics/administration & dosage , Ketamine/administration & dosage , Pain, Postoperative/prevention & control , Infusions, Intravenous , Prospective Studies , Analysis of Variance , Treatment Outcome
5.
China Journal of Orthopaedics and Traumatology ; (12): 349-353, 2021.
Article in Chinese | WPRIM | ID: wpr-879442

ABSTRACT

OBJECTIVE@#To explore the diagnosis, treatment, cause and prevention of nerve compression by bone fragment after lumbar spine surgery.@*METHODS@#The clinical data of 23 patients with nerve compression by bone fragment after lumbar spine surgery from February 2012 to March 2019 were collected retrospectively, including 9 males and 14 females, aged 42 to 81 years with an average of (62.60±5.70) years. The surgical methods included lumbar interbody fusion in 20 cases and spinal endoscopy in 3 cases. All 23 patients experienced radiating pain on the decompression side or the contralateral limb after operation. The time of occurrence was from immediately after operation to 2 weeks after operation, with an average of (3.2±1.7) days. All patients underwent postoperative examination of lumbar spine CT or MRI to confirm residual ectopic bone fragments, and at the same time, bilateral lower extremity color Doppler ultrasound excluded thrombosis. Sources of ectopic bone fragments:14 cases of residual bone fragments caused by intervertebral fusion bone graft loss or fenestration fusion, 6 cases of fractured upper articular process head, and 3 cases of upper articular process bone remaining during spinal endoscopic surgery.@*RESULTS@#The patient's hospital stay was 10 to 37 (23.4±6.2) days. All patients were followed up for 6 to 25 (13.6±3.4) months. Three patients underwent posterior open nerve root exploration for removing bone fragments on the same day or the second day after surgery, and the symptoms were relieved. Twenty patients underwent conservative treatment firstly, and 13 patients were discharged after pain relieved by conservative treatment, 7 patients failed conservative treatment, the 2 cases of failed 7 cases had undergone nerve root block surgery during conservative treatment. Two patients underwent spinal endoscopy nerve root exploration and bone mass removal, and five patients underwent posterior open nerve root exploration and bone fragmentation removal. All postoperative pain symptoms were relieved. Preoperative CT, MRI and intraoperative bone fragment removal confirmed the shape and location of the bone fragments. The most likely source of bone fragments was the loss of intervertebral fusion bone grafts or residual bone fragments resulting from fenestration fusion (14 cases), fractured upper articular process head (6 cases), and upper articular process bones remaining in endoscopic surgery (3 cases). According to the Macnab criteria in evaluating clinical outcome, 20 cases got excellent results and 3 good.@*CONCLUSION@#After the lumbar spine surgery, the nerve compression by bone fragments is treated with appropriate treatments, and good clinical results can be obtained. Timely removal of residual bone fragments during operation and careful exploration of nerve roots before closing incision can avoid such complications.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Decompression, Surgical , Endoscopy , Lumbar Vertebrae/surgery , Retrospective Studies , Spinal Fusion/adverse effects , Treatment Outcome
7.
China Journal of Orthopaedics and Traumatology ; (12): 1142-1147, 2020.
Article in Chinese | WPRIM | ID: wpr-879369

ABSTRACT

OBJECTIVE@#To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures.@*METHODS@#There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury.@*RESULTS@#The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(@*CONCLUSION@#Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lumbar Vertebrae/surgery , Lumbosacral Region , Pedicle Screws , Retrospective Studies , Spinal Fusion/adverse effects , Treatment Outcome , Vascular System Injuries/surgery
8.
Rev. Assoc. Med. Bras. (1992) ; 65(2): 198-203, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-990341

ABSTRACT

SUMMARY OBJECTIVE: To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used. METHODS: Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws. RESULTS: Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series. CONCLUSION: Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used


RESUMO OBJETIVO: Apresentar os resultados cirúrgicos de pacientes submetidos à instrumentação com parafusos do áxis, discutindo nuances cirúrgicas e complicações das técnicas utilizadas. MÉTODOS: Série retrospectiva de pacientes submetidos à instrumentação do áxis utilizando parafusos. RESULTADOS: Sessenta e cinco pacientes foram incluídos neste estudo. A causa mais comum de instabilidade foi trauma raquimedular envolvendo o áxis (36 pacientes - 55,4%), seguida por malformação craniocervical congênita (12 pacientes - 18,5%). Trinta e sete (57%) pacientes necessitaram concomitante fusão de C1. Fixação bilateral foi realizada em quase todos os casos. Vinte e três pacientes (35,4%) foram submetidos à fixação com parafusos de lâmina; parafusos de pars foram utilizados em 22 pacientes (33,8%) e de pedículo, isoladamente, em três (4,6%). Em 14 casos (21,5%), realizamos técnicas combinadas. Não houve piora neurológica ou lesão de artéria vertebral nesta série de casos. CONCLUSÃO: A instrumentação com parafusos do áxis foi um método seguro e eficaz para estabilização cervical. A fixação da lâmina e a da pars foram as técnicas mais utilizadas.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Young Adult , Spinal Fusion/instrumentation , Axis, Cervical Vertebra/surgery , Bone Screws/adverse effects , Postoperative Complications , Spinal Fusion/adverse effects , Spinal Fusion/methods , Retrospective Studies , Treatment Outcome , Middle Aged
9.
West Indian med. j ; 67(1): 39-45, Jan.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-1045813

ABSTRACT

ABSTRACT Objective: Dysphagia is a relatively common occurrence in the postoperative period following anterior cervical surgery, with some indicating rates as high as 79%. In most cases, it remains only a transient phenomenon. The cause has been debated, with most speculating injury to nerves in the swallowing mechanism. The objective of this study was to determine if the presence of instrumentation during anterior cervical surgery in the outpatient setting would affect the incidence, duration and severity of dysphagia. Methods: We did a retrospective review of the medical records of 50 consecutive patients who had undergone single-level instrumented anterior cervical discectomy and fusion. Then we compared that group with our control group of 50 patients who had had simple single-level anterior cervical discectomy without instrumentation or fusion. The patients were evaluated for the presence of dysphagia as well as neck disability index outcome scores. Results: There was no significant difference between the groups in postoperative neck disability index outcomes at the two-year follow-up (p = 0.182). Dysphagia occurred only in the instrumented group, with an incidence of 12% (six patients): their symptoms lasted on average three weeks, and all six patients experienced only mild severity on the Bazaz-Yoo scale. There was statistically significant difference between the two groups (p = 0.012). Conclusion: There was a greater trend towards postoperative dysphagia in cases with instrumentation (12% of the patients). Dysphagia was transient with mild severity in patients who received instrumentation compared with those who underwent discectomy alone.


RESUMEN Objetivo: La disfagia es una ocurrencia relativamente común en el período postoperatorio después de la cirugía cervical anterior, con algunas tasas indicadoras tan altas como 79%. En la mayoría de los casos, sigue siendo sólo un fenómeno transitorio. Su causa ha sido discutida, atribuyéndose principalmente a una lesión en los nervios del mecanismo de deglución. El objetivo de este estudio fue determinar si la presencia de la instrumentación durante la cirugía cervical anterior en el contexto ambulatorio afectaría la incidencia, duración y severidad de la disfagia. Métodos: Realizamos una revisión retrospectiva de las historias clínicas de 50 pacientes consecutivos que habían tenido discectomía y fusión cervical anterior con instrumentación a un solo nivel. Entonces comparamos ese grupo con nuestro grupo de control de 50 pacientes a quienes se les había practicado una discectomía cervical anterior a un solo nivel simple sin instrumentación o fusión. Los pacientes fueron evaluados con respecto a la presencia de disfagia, así como en relación con las puntuaciones del resultado del índice de la discapacidad cervical. Resultados: No hubo diferencias significativas entre los grupos en cuanto a los resultados del índice de discapacidad cervical postoperatorio en el seguimiento de dos años (p = 0.182). La disfagia se produjo sólo en los grupos con instrumentación, con una incidencia de 12% (seis pacientes): sus síntomas duraron un promedio de tres semanas, y los seis pacientes experimentaron toda una severidad leve en la escala de Bazaz-Yoo. Hubo una diferencia estadísticamente significativa entre los dos grupos (p = 0.012). Conclusión: Hubo una mayor tendencia a la disfagia postoperatoria en los casos con instrumentación (12% de los pacientes). La disfagia fue transitoria con severidad leve en los pacientes que recibieron instrumentación, comparada con la de los que experimentaron discectomía solamente.


Subject(s)
Humans , Male , Female , Adult , Spinal Fusion/adverse effects , Deglutition Disorders/etiology , Diskectomy/adverse effects , Severity of Illness Index , Incidence , Retrospective Studies , Diskectomy/instrumentation
10.
Rev. chil. cir ; 70(5): 460-463, 2018. ilus
Article in Spanish | LILACS | ID: biblio-978016

ABSTRACT

Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.


Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.


Subject(s)
Humans , Female , Middle Aged , Spinal Fusion/adverse effects , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Arthrodesis/adverse effects , Magnetic Resonance Imaging , Treatment Outcome , Esophageal Perforation/diagnostic imaging
11.
Coluna/Columna ; 15(3): 226-229, July-Sept. 2016. tab
Article in English | LILACS | ID: lil-795010

ABSTRACT

ABSTRACT Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%.


RESUMO Objetivo: Identificar os fatores relacionados a não ocorrência de subsidência de cage em procedimentos de fusão lombar intersomática por via lateral em um só nível. Métodos: Estudo de caso controle em fusão intersomática lombar por via lateral (LLIF) em um só nível, incluindo 86 casos. Os pacientes sem subsidência do cage formaram o grupo controle (C), enquanto os do grupo subsidência (S) desenvolveram subsidência do cage. Os dados pré-operatórios foram examinados para criar um escore de risco com base em fatores de correlação com o grupo S. Os fatores de risco comprovados fizeram parte de um escore de avaliação. Resultados: Dos 86 casos incluídos, 72 estavam no grupo C e 14 no grupo S. Os seguintes fatores de risco foram mais prevalentes no grupo S com relação ao grupo C: espondilolistese (93% vs. 18%; p < 0,001); escoliose (31% vs. 12%; p = 0,033); mulheres (79% vs. 38%; p = 0,007); pacientes idosos (média de 57,0 vs. 68,4 anos; p = 0,001). Esses fatores de risco foram utilizados em um escore (0-4) para avaliar o risco em cada caso. Os pacientes com escores mais altos de risco tiveram maior subsidência (p < 0,001). Os escores ≥ 2 foram preditivos de subsidência com sensibilidade de 92% e especificidade de 72%. Conclusões: Foi possível correlacionar o grau de subsidência em procedimentos LLIF em um só nível com a utilização de dados demográficos (idade e sexo) e patológicos (espondilolistese e escoliose). Com um escore baseado em fatores de risco e considerando qualquer pontuação <2, a probabilidade de não ocorrência de subsidência depois de LLIF em um só nível (valor preditivo negativo) foi de 98%.


RESUMEN Objetivo: Identificar los factores relacionados con la ausencia de subsidencia de cage en los procedimientos de fusión intersomática lumbar por vía lateral en un solo nivel. Métodos: Estudio de caso-control en la fusión intersomática lumbar por vía lateral (LLIF) en un solo nivel, incluyendo 86 casos. Los pacientes sin subsidencia del cage formaron el grupo control (C), mientras que el grupo de subsidencia (S) desarrolló subsidencia del cage. Los datos preoperatorios fueron examinados para crear una puntuación de riesgo basada en factores de correlación con el grupo S. Los factores de riesgo comprobados formaron parte de una puntuación de evaluación. Resultados: De los 86 casos incluidos, 72 formaron el grupo C y 14 el grupo S. Los siguientes factores de riesgo son más prevalentes en el grupo S con respecto al grupo C: espondilolistesis (93% vs. 18%, p <0,001); escoliosis (31% vs. 12%, p = 0,033); mujeres (79% vs. 38%, p = 0,007); ancianos (media de 57,0 a 68,4 años; p = 0,001). Estos factores de riesgo se utilizaron en una puntuación (0-4) para evaluar el riesgo en cada caso. Los pacientes con puntuaciones más altas de riesgo tuvieron mayor subsidencia (p < 0,001). Las puntuaciones ≥ 2 fueron predictivas de la subsidencia con una sensibilidad del 92% y una especificidad del 72%. Conclusiones: Se ha podido relacionar el grado de subsidencia en los procedimientos LLIF en un solo nivel con el uso de los datos demográficos (edad y sexo) y patológicos (espondilolistesis y escoliosis). Con una puntuación basada en factores de riesgo y considerado un puntaje < 2, la probabilidad de no ocurrencia de subsidencia después de LLIF en un solo nivel (valor predictivo negativo) fue del 98%.


Subject(s)
Humans , Spinal Fusion/adverse effects , Risk Factors , Patient Selection , Lumbar Vertebrae
12.
Clinics in Orthopedic Surgery ; : 268-273, 2016.
Article in English | WPRIM | ID: wpr-93987

ABSTRACT

BACKGROUND: For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. METHODS: Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. RESULTS: The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. CONCLUSIONS: Posterior decompression with instrumented fusion is a safe and effective approach for management of patients with lumbar and lumbosacral tuberculosis.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Back Pain , Cohort Studies , Decompression, Surgical/adverse effects , Lumbosacral Region/surgery , Pain Measurement , Postoperative Complications , Spinal Fusion/adverse effects , Tuberculosis, Spinal/surgery
13.
Coluna/Columna ; 14(2): 121-124, Apr.-June 2015. tab, ilus
Article in English | LILACS | ID: lil-755854

ABSTRACT

OBJECTIVE:

To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.

METHODS:

Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.

RESULTS:

Eight (66.67%) patients were male and four patients (33.33%) were females aged 13-66 years (mean 40 years). There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.

CONCLUSION:

Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.

.

OBJETIVO:

Descrever a técnica cirúrgica de vertebrectomia por acesso único posterior na coluna torácica e toracolombar com reconstrução circunferencial e artrodese e avaliar retrospectivamente os resultados e complicações após 2 anos de seguimento dos pacientes submetidos à técnica.

MÉTODOS:

Análise retrospectiva de prontuários e exames de imagem de doze pacientes com indicação de vertebrectomia por diversas patologias, submetidos a essa técnica cirúrgica.

RESULTADOS:

Oito (66,67%) pacientes eram do sexo masculino e quatro (33,33%) do sexo feminino, com idade variando de 13 a 66 anos (média de 40 anos). Nove pacientes com comprometimento da coluna torácica e três da lombar, sendo em um paciente, duas vértebras consecutivas afetadas. Todos os pacientes tiveram melhora ou permaneceram com o estado neurológico inalterado. As complicações cirúrgicas foram dois casos de hemotórax, dois casos de soltura dos parafusos, um deles necessitando de revisão cirúrgica e um caso de falha do material e pseudoartrose.

CONCLUSÃO:

A vertebrectomia por acesso único posterior da coluna torácica e toracolombar com reconstrução circunferencial e artrodese pode ser realizada de forma segura para uma variedade de indicações.

.

OBJETIVO:

Describir la técnica quirúrgica para la vertebrectomía por acceso posterior único de la columna torácica y toracolumbar con la reconstrucción y artrodesis circunferencial y evaluar retrospectivamente los resultados y las complicaciones de los pacientes sometidos a la técnica después de dos años de seguimiento.

MÉTODOS:

Análisis retrospectivo de las historias clínicas e estudios de imágenes de pacientes con indicación para vertebrectomía por diversas patologías.

RESULTADOS:

Ocho (66,67%) pacientes eran varones y cuatro (33,33%) mujeres con edades entre 13 y 66 años (media 40 años). Había nueve pacientes con afectación de la columna torácica y tres de la lumbar siendo que un paciente tenía dos vértebras consecutivas afectadas. Todos los pacientes mejoraron o mantuvieron el estado neurológico. Las complicaciones quirúrgicas fueron dos casos de hemotórax, dos casos de aflojamiento de los tornillos, uno de éstos requiriendo revisión quirúrgica y un caso de falla del material y pseudoartrosis.

CONCLUSIÓN:

La vertebrectomía por acceso único posterior de la columna dorsal o dorsolumbar con la reconstrucción y artrodesis circunferencial puede realizarse con seguridad para una variedad de indicaciones.

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Subject(s)
Humans , Surgical Procedures, Operative/methods , Arthrodesis , Spinal Fusion/adverse effects , Fracture Fixation
14.
Clinics in Orthopedic Surgery ; : 323-329, 2015.
Article in English | WPRIM | ID: wpr-127324

ABSTRACT

BACKGROUND: A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. METHODS: The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. CONCLUSIONS: No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.


Subject(s)
Humans , Decompression, Surgical , Postoperative Complications , Spinal Fusion/adverse effects , Spinal Stenosis/physiopathology
15.
Clinics in Orthopedic Surgery ; : 337-343, 2015.
Article in English | WPRIM | ID: wpr-127322

ABSTRACT

BACKGROUND: Previous reports have observed differences only in infection rates between posterolateral fusion and posterior lumbar interbody fusion (PLIF). There have been no reports that describe the particular features of surgical site infection (SSI) in PLIF. In this study, we endeavor to identify the distinguishing characteristics and risk factors of SSI in PLIF. METHODS: Our study undertook a review of a case series of an institute. Patients who had undergone PLIF consecutively in the author's hospital were reviewed. Two proactive procedures were introduced during the study period. One was irrigation of the autolocal bone, and the other was the intradiscal space irrigation with a nozzle. Infection rate and risk factors were analyzed. For subgroup analysis, the elapsed time to a diagnosis (ETD), clinical manifestations, hematologic findings, and causative bacteria were examined in patients with SSI. RESULTS: In a total of 1,831 cases, there were 30 cases of SSI (1.6%). Long operation time was an independent risk factor (p = 0.008), and local bone irrigation was an independent protective factor (p = 0.001). Two cases of referred SSI were included in the subgroup analysis. There were 6/32 (19%) superficial incisional infections (SII), 6/32 (19%) deep incisional infections (DII), and 20/32 (62%) organ/space infections (O/SI). The difference of incidence among three groups was significant (p = 0.002).The most common bacteria encountered were methicillin-resistant Staphylococcus epidermidis followed by methicillin-resistant S. aureus in incisional infections, and no growth followed by S. epidermidis in O/SI. ETD was 8.5 +/- 2.3 days in SII, 8.7 +/- 2.3 days in DII and 164.5 +/- 131.1 days in O/SI (p = 0.013). CONCLUSIONS: The rate of SSI in PLIF was 1.6%, with the most common type being O/SI. The causative bacteria of O/SI was of lower virulence than in the incisional infection, and thus diagnosis was delayed due to its latent and insidious feature. Contamination of auto-local bone was presumed attributable to the progression of SSI. Irrigation of auto-local bone helped in the reduction of SSI.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Incidence , Lumbar Vertebrae/surgery , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Spinal Fusion/adverse effects , Surgical Wound Infection/diagnosis
16.
Clinics in Orthopedic Surgery ; : 344-350, 2015.
Article in English | WPRIM | ID: wpr-127321

ABSTRACT

BACKGROUND: Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival. METHODS: From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis. RESULTS: Most patients experienced improvements in pain and performance status (12.3% +/- 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation. CONCLUSIONS: There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Back Pain , Decompression, Surgical/adverse effects , Kaplan-Meier Estimate , Liver Neoplasms/pathology , Lung Neoplasms/pathology , Pain, Intractable , Palliative Care/methods , Prognosis , Retrospective Studies , Spinal Fusion/adverse effects , Spinal Neoplasms/mortality , Spine/surgery
17.
Clinics in Orthopedic Surgery ; : 91-96, 2015.
Article in English | WPRIM | ID: wpr-119051

ABSTRACT

BACKGROUND: As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). METHODS: We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. RESULTS: Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). CONCLUSIONS: We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Learning Curve , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures/adverse effects , Retrospective Studies , Spinal Diseases/surgery , Spinal Fusion/adverse effects
18.
Yonsei Medical Journal ; : 1627-1631, 2015.
Article in English | WPRIM | ID: wpr-70410

ABSTRACT

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adjuvants, Anesthesia/administration & dosage , Antiemetics/administration & dosage , Gastrointestinal Motility/drug effects , Injections, Intravenous , Intestinal Pseudo-Obstruction/drug therapy , Lumbar Vertebrae/diagnostic imaging , Metoclopramide/administration & dosage , Postoperative Complications/epidemiology , Prevalence , Prone Position , Prospective Studies , Republic of Korea , Scopolamine/administration & dosage , Spinal Fusion/adverse effects , Supine Position , Treatment Outcome
19.
Clinics in Orthopedic Surgery ; : 468-475, 2014.
Article in English | WPRIM | ID: wpr-223876

ABSTRACT

BACKGROUND: There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]). METHODS: In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered. RESULTS: DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group. CONCLUSIONS: Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.


Subject(s)
Aged , Humans , Arthroplasty, Replacement, Knee/adverse effects , Fracture Fixation/adverse effects , Hemodynamics , Intermittent Pneumatic Compression Devices , Knee/surgery , Prospective Studies , Risk Factors , Spinal Fusion/adverse effects , Spine/surgery , Treatment Outcome , Venous Thrombosis/etiology
20.
Coluna/Columna ; 12(4): 315-318, 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-699038

ABSTRACT

OBJETIVO: Verificar a existência de lesões neurológicas nos pacientes submetidos à instrumentação com parafusos pediculares mal posicionados na região toracolombar. MÉTODOS: Estudo prospectivo com seleção randômica de 30 pacientes submetidos à instrumentação pedicular por via posterior, pela técnica freehand. Foi avaliada comparativamente, de forma cega, a adequação do posicionamento dos parafusos nas vértebras por meio de tomografias. A seguir, tentou-se correlacionar a existência de alterações neurológicas relacionadas ao posicionamento dos implantes. RESULTADOS: Observados 223 parafusos pediculares na coluna toracolombar em 30 pacientes operados no serviço por diversas doenças. Houve violação da parede do pedículo vertebral em 33% dos pacientes, sendo mais da metade com invasão da cortical medial. A piora neurológica no pós-operatório imediato ocorreu em três pacientes, entretanto apenas um parafuso precisou de reposicionamento. Todos os pacientes recuperaram a situação neurológica pré-cirúrgica. CONCLUSÕES: O índice de violação cortical com parafusos pediculares mostrou-se elevado. Contudo, nota-se que pequenas violações pediculares podem causar danos neurológicos e que, quando esses acontecem, são reversíveis se o erro for corrigido.


OBJECTIVE: To verify the presence of neurological damages in patients submitted to instrumentation with thoracolumbar pedicle screws misplacement. METHODS: Prospective study with a random selection of 30 patients submitted to pedicular instrumentation by posterior approach with freehand technique. Screws vertebral positioning was comparatively and blindly evaluated with tomographies. Then, we tried to correlate neurological status with screws placement. RESULTS: Thirty patients submitted to spinal surgery at this hospital for any disease had instrumentation with 223 pedicle screws. Vertebral pedicle wall violation was observed in 33% of cases, and more than half of them had medial cortical breach. Neurological worsening occurred in three patients in the immediate postoperative period, but only one screw needed repositioning. All patients recovered the previous neurological status. CONCLUSION: A high level of pedicle screw cortical violation was observed. However, small pedicle breaches may originate neurological damages and, when they occur, the lesions are reversible if the misplaced screws are corrected.


OBJETIVO: Comprobar si hay lesiones neurológicas en pacientes sometidos a la instrumentación con tornillos pediculares mal posicionados en la región toracolumbar. MÉTODOS: Se realizó un estudio prospectivo con selección aleatoria de 30 pacientes sometidos a la instrumentación pedicular posterior a través de la técnica "freehand". Se evaluó comparativamente en forma ciega, la conveniencia de la colocación de tornillos en las vértebras con visualización por TC. A continuación, tratamos de correlacionar la presencia de trastornos neurológicos relacionados con la colocación de los implantes. RESULTADOS: Fueron observados 223 tornillos pediculares en la columna toracolumbar en 30 pacientes operados en el servicio debido a diversas enfermedades. Hubo una violación de la pared del pedículo en un 33% de los casos, siendo que más de la mitad con invasión de la cortical medial. El empeoramiento neurológico en el postoperatorio inmediato se produjo en tres pacientes, aunque fue necesario cambiar la posición de un solo tornillo. Todos los pacientes recuperaron su estado neurológico preoperatorio. CONCLUSIONES: La tasa de violación cortical con tornillos pediculares fue alta. No obstante, se observó que las pequeñas violaciones pediculares pueden causar daño neurológico y que cuando esto sucede, es reversible si se corrige el error.


Subject(s)
Humans , Bone Screws/adverse effects , Spinal Fusion/adverse effects , Spinal Fusion/instrumentation , Spine/surgery , Neurologic Manifestations
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