Surgical outcome of reduction and instrumented fusion in lumbar degenerative spondylolisthesis

Background: Lumbar degenerative spondylolisthesis [LDS] is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion

Methods: This before-after study was carried out on 45 patients [37 female and 8 male] with LDS operated from August 2008 to January 2011. The patients' pain and disability were assessed by visual analogue scale [VAS] and Oswestry disability index [ODI] questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis

Results: The mean age of patients and mean follow-up period were 58.3 +/- 3.5 years and 31.2 +/- 4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation

Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement

Primary epidural varicosis as a rare cause of sciatica: a case report

Non-discogenic sciatica can be caused by any lesion along the course of the lumbosacral nerve roots and sciatic nerve. We aim to present a rare case of refractory sciatica in an otherwise healthy 25-year-old man. He complained of left leg pain without significant back pain. Extensor hallucis longus muscle was weak on the left side with limited straight leg rising. On magnetic resonance imaging, a space-occupying lesion resembling a sequestrated disc was noted that after surgical decompression, epidural varicosis was demonstrated

Sciatica in a Five-Year-Old Boy

The prevalence of back pain during childhood is 50%; in 22% of these cases, a specific diagnosis can be found. Osteoid osteoma is a rare benign tumor that occursonly in 20% of cases and involves the spine. The aim of this report is to explain an atypical case of lumbar osteoid osteoma with significant neurologic deficit at a very young age. A five-year-old boy was presented with refractory pain in the low back and left extremity for approximately one year. Positive clinical findings were antalgic gait, stiff lumbar spine, weak left big toe extension force and a positive straight leg rising test on the left side. Paraclinical studies revealed osteoid osteoma in the left-sided pedicle of the fifth lumbar vertebra. With surgical excision, he recovered immediately. Lumbar osteoid osteoma should be suspected as the cause of low back pain or sciatalgia in any young patient.

Comparison of Functional Outcomes following Surgical Decompression and Posterolateral Instrumented Fusion in Single Level Low Grade Lumbar Degenerative versus Isthmic Spondylolisthesis

BACKGROUND: The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. METHODS: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 +/- 6.1 years, and group B included 52 patients with a mean age of 47.3 +/- 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. RESULTS: The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. CONCLUSIONS: Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.

Comment on: Sciatica in the Young

No abstract available.

Posterior Surgery Alone in the Treatment of Post-traumatic Kyphosis by Posterior Column Osteotomy, Spondylodesis, Instrumentation, and Vertebroplasty

STUDY DESIGN: Retrospective study. PURPOSE: To determine if posterior surgery alone can satisfactorily treat post-traumatic kyphosis (PTK). OVERVIEW OF LITERATURE: One of the worst complications of vertebral fractures is PTK. The type of surgery and approach to treat a symptomatic and refractory PTK is a challenging issue in spinal surgery, and yet, there is no specific treatment algorithm. METHODS: From August 2003 to September 2010, we collected 26 cases (male to female ratio, 2.25; mean age, 31.9+/-9.7 years and follow-up period of 42.4+/-8.1 months) with PTK treated by posterior column osteotomy, spondylodesis, instrumentation and cement vertebroplasty in one stage posterior surgery. PTK angle, Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction from surgery were used to determine the results. We used a student t test for analyzing the data before and after surgery. RESULTS: In our patients, T11 and L1 had the highest incidence of vertebral fractures. The results indicated that in PTK, ODI, and VAS were significantly improved this surgery. Solid fusion occurred in 96.2% of patients with 3.2degrees+/-2.1degrees loss of correction. A total of 84.6% of patients have satisfaction level of excellent and good. CONCLUSIONS: Posterior surgery alone with posterior column osteotomy, vertebroplasty, posterior spinal fusion and instrumentation can effectively treat symptomatic PTK.

Treatment Outcomes of Open Pelvic Fractures Associated with Extensive Perineal Injuries

BACKGROUND: The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. METHODS: We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. RESULTS: The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. CONCLUSIONS: Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.