ABSTRACT
BACKGROUND: Lumbar spinal fusion is an established surgical technique in spine surgery. The goal of spinal fusion is a biomechanically lasting interbody union, which can be accomplished through different surgical approaches, implants and grafts. TECHNIQUES: The mainly surgical techniques used are: posterior lumbar fusion (PLF), posterior interbody lumbar fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF). These procedures, their indications, complications and results are described in this narrative review.
Subject(s)
Bone Diseases, Developmental , Spinal Diseases , Spinal Fusion , Humans , Lumbar Vertebrae , Lumbosacral RegionABSTRACT
Introduction: The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime. Method: Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS ≥ 16 and admission to trauma room during "DAY" (8 am to 4â:â49 pm) or "NIGHT" (9 pm to 5â:â59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period. Results: The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (± 16.4) vs. 31.1 (± 14.2), p = 0.015 and younger: 33.3 (± 16.6) vs. 43.6 (± 22.3) years old, p < 0.001. However, this had no impact on outcome prediction scores like RISC, RISC2 or TRISS, p ≥ 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (± 3.7) vs. DAY 5.0 (± 3.7) min, p = 0.116, time for splinting 3.8 (± 3.7) vs. 3.4 (± 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (± 11.2) vs. 26.6 (± 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8â% of the NIGHT-patients (RISC-prognosis: 23.8â%, SMR 0.74) died in hospital, and 18.3â% of the DAY-patients (RISC-prognosis: 24.0â%, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (± 1.5) vs. DAY 3.8 (± 1.6), p = 0.491. Discussion: Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment.
Subject(s)
After-Hours Care/standards , Emergency Medical Services/standards , Multiple Trauma/therapy , Adolescent , Adult , Aged , Circadian Rhythm , Cohort Studies , Critical Care/standards , Female , Germany , Health Services Research , Hospital Mortality , Humans , Injury Severity Score , Male , Middle Aged , Multiple Trauma/mortality , Outcome and Process Assessment, Health Care , Quality Assurance, Health Care/standards , Retrospective Studies , Trauma Centers/standards , Vital Signs , Young AdultABSTRACT
Delayed fracture healing for more than 6-8 months is defined as non-union (pseudarthrosis). Non-unions are classifiable as septic, aseptic, hypertrophic and atrophic non-unions. In case of septic non-unions the infection is treated primarily followed by treatment of the delayed fracture healing. Aseptic non-unions may be treated non-operatively (e.g. shock wave therapy and/or ultrasound) or by various surgical strategies to stimulate bone regeneration and healing.
