Minimally versus conventional-invasive transforaminal lumbar interbody fusion in patients with failed back surgery syndrome.

BACKGROUND: Failed back surgery syndrome is an important cause of back and leg pain after spinal surgery. Transforaminal lumbar interbody fusion (TLIF) is commonly used in revision surgery for failed back surgery syndrome. In the literature, there is a lack of evidence concerning the minimally and conventional-invasive TLIF and debates are ongoing. The purpose of the present study was to compare efficacy and safety of minimally versus conventional-invasive TLIF for failed back surgery syndrome. MATERIALS AND METHODS: This study was conducted according to the STROBE Statement. Between 2011 and 2014, thirty patients with failed back surgery syndrome underwent TLIF. Group I (15 patients) received minimally invasive TLIF through paramedian approach using microscopy and fluoroscopy. Group II (15 patients) received conventional-invasive TLIF. Minimum follow-up was 12 months. RESULTS: There was a significant improvement of Oswestry Disability Index (ODI) and visual analogue scale (VAS) in both groups postoperatively. There was no statistically significant difference between both groups regarding ODI, VAS, leg and back pain pre- and postoperatively. There was a tendency to better postoperative ODI and VAS scores in group I; however this did not reach the statistical significance. One case showed adjacent segment degeneration in group I. In group II, one case had screw mal-positioning with foot drop. Another case had dural injury with postoperative fistula. CONCLUSION: TLIF is a valuable option after failed back surgery syndrome providing statistically significant improvement postoperatively. Both minimally and conventional-invasive TLIF represent a safe and reliable treatment of patients with failed back syndrome, achieving satisfactory outcome along with low rate of complications. Although the minimally invasive TLIF scored better, these differences did not reach the threshold of significance.

Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian network meta-analysis.

Despite the numerous studies, there is no consensus concerning the best approach for total hip arthroplasty (THA), and debates are ongoing. The purpose of this study was to perform a Bayesian network meta-analysis (NMA) comparing several approaches for primary THA. The focus was on peri-operative outcomes: surgical duration, total estimated blood loss, and length of the hospitalization. This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. In October 2019, the main databases were accessed. All the clinical trials comparing two or more different approaches for primary THA were assessed. For the methodology quality assessment, the PEDro score was performed. The Software STATA MP was used for the statistical analyses. The NMA was performed through the routine for Bayesian hierarchical random-effects analysis with the inverse variance statistic method for continuous variables. Data from 4843 procedures was analysed. Between patient's demographic, good baseline comparability was found. The comparison total estimated blood loss detected statistically significant inconsistency (P = 0.01). The posterolateral approach reported the lowest value for the surgical duration. The test for overall inconsistency was statistically significant (P = 0.4). The posterolateral approach reported the shortest hospitalization length. The test for overall inconsistency was statistically significant (P = 0.9). The posterolateral approach reported shorter surgical duration and hospitalization length. Concerning the analysis of total estimated blood loss, no significant result was obtained. Data must be considered in the light of the limitations of the present study.

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis.

BACKGROUND: Recent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS. METHODS: Sixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses. RESULTS: Variance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning. CONCLUSION: Depression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

[Fusion in adolescent idiopathic scoliosis : Anterior, posterior or combined? One-stage or two-stage?]. / Korrekturspondylodesen von adoleszenter idiopathischer Skoliose : Ventral, dorsal, ventrodorsal? Einzeitig oder zweizeitig?

Scoliosis is a complex, three-dimensional spinal deformity with various causes. Adolescent idiopathic scoliosis (AIS) is the most common form. Surgical treatment is indicated for curves greater than 45-50° meaured using the Cobb method. We can distinguish among posterior, anterior or combined surgical procedures. Today, the posterior, transpedicular approach has revolutionized scoliosis surgery. This review gives an overview of current surgical options in scoliosis treatment.