Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review.

STUDY DESIGN: Retrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period. OBJECTIVES: To assess the incidence, treatment, clinical consequence, complications of incidental durotomy during spine surgery and results of 37 months clinical follow-up. SUMMARY OF BACKGROUND DATA: Incidental durotomy is an underestimated and relatively adverse event during spinal surgery. Several consequences of inadequately treated dural tears have been reported. METHODS: A retrospective review was conducted on 1326 consecutive patients who underwent spinal surgery performed in one French spine unit from January 2005 to December 2005. We excluded from this study patients treated for emergency spine cases. RESULTS: Fifty-one dural tears were identified (3.84%). Incidental durotomies were associated with anterior cervical approach in 1 case, with posterior cervical approach in 1 case, with anterior retroperitoneal approach in 1 case and with posterior thoracolumbar approach in 48 cases. In addition, any clinically significant durotomy unrecognised during surgical procedure were included. Thirteen patients presented postoperative complications including 7 cerebrospinal fluid leaks, 2 wound infections, 2 postoperative haematomas, and 2 pseudomeningoceles. Nine of these 13 patients required a revision procedure. A mean follow-up of 37 months showed good long-term clinical results. CONCLUSIONS: Incidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.

Center of gravity and radiographic posture analysis: a preliminary review of adult volunteers and adult patients affected by scoliosis.

STUDY DESIGN: This is a prospective radiographic and force plate analysis involving adult volunteer and patients with scoliosis. OBJECTIVE: To assess accurately the center of pressure in standing volunteers and patients with scoliosis, and correlate these finding with radiographic data. SUMMARY OF BACKGROUND DATA: A simple and commonly applied parameter of global balance is the plumbline offset. This radiographic measurement refers to the center of C2 (or C7) drawn vertically downward. Although this measurement is simple, it may not accurately reflect the balance of the spine. METHODS: This study included adult volunteers (n = 41) and patients with scoliosis (n = 45). Full-length, freestanding spine radiographs were obtained with subjects on a force plate. Simultaneous assessment of the radiologic spinal posture and the floor projection of the center of pressure (gravity line) was possible. The latter was projected on the full spine images and correlated to common radiographic parameters. RESULTS: The position of the gravity line differed significantly from the plumbline in frontal and sagittal planes (P < 0.001). This difference was maintained in both study populations. The mean frontal plane alignment of the gravity line was consistently to the right of the plumbline. The mean sagittal plane alignment of the gravity in relation to the plumbline revealed an offset anteriorly. CONCLUSIONS: The data analysis of offsets between the gravity line and radiographic parameters revealed a frontal plane mean displacement of the gravity line to the right. In the sagittal plane, a highly significant lack of correlation between the gravity line and plumbline was noted. The plumbline represents a common and convenient visual display of apparent sagittal plane imbalance, but its value as a marker of true postural balance must be questioned.

Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.

STUDY DESIGN: A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. OBJECTIVES: To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population. SUMMARY OF BACKGROUND DATA: There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters. METHODS: There were 75 subjects in the study. Inclusion criteria were: age > or =60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65-74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated. RESULTS: The mean age of the patients in this study was 70.5 years (range 60-90). Mean Cobb angle was 17 degrees in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10 degrees). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect the targeted selection of an elderly group. Although many patients with adult scoliosis have pain and dysfunction, there appears to be a large group (such as the volunteers in this study) that has no marked physical or social impairment. CONCLUSIONS: Previous reports note a prevalence of adult scoliosis up to 32%. In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years. This study found no significant correlations between adult scoliosis and visual analog scale scores or nutritional status in healthy, elderly volunteers.