Surgical management of complex post-tuberculous kyphosis among African patients: clinical and radiographic outcomes for a consecutive series treated at a single institution in West Africa.

STUDY DESIGN: Retrospective review of consecutive series. OBJECTIVE: To assess the clinical and radiographic outcomes after surgical management of post-tuberculous kyphosis. Post-tuberculous (TB) kyphosis can lead to progressive pulmonary and neurological deterioration. Surgery is indicated to decompress neural elements and correct the spine deformity. Although posterior vertebral column resection (PVCR) has been established as the treatment of choice for severe TB kyphosis, there is paucity of studies on the clinical outcomes among patients treated in West Africa. METHODS: Clinical and radiographic data of 57 patients (pts) who underwent surgical correction of post-TB kyphosis at a single site in West Africa between 2013 and 2018 (≥ 2-year follow-up in 36 pts, ≥ 1-year FU in 21 pts). Pre- and post-op SRS scores and radiographic outcomes were compared using Paired t test. RESULTS: 57 patients, 36M:21F. Mean age 19 (11-57 years). 22/57 pts (39.3%) underwent pre-op halo gravity traction (HGT) for an average duration of 86 days (8-144 days). HGT pts had a higher baseline regional kyphosis (125.1 ± 20.9) compared to non-HGT pts (64.6 ± 31.8, p < 0.001). Post-HGT regional kyphosis corrected to 101.2 ± 23 (24° correction). 53 pts (92.9%) underwent posterior-only surgery and 4 (7.0%) combined anterior-posterior surgery. 39 (68.4%) had PVCR, 11 (19.3%) PSO, and 16 (28.1%) thoracoplasty. Intraoperative neuromonitoring (IOM) signal changes occurred in 23/57 pts (≈ 40%), dural tear in 5 pts (8.8%), pleural tear in 3 pts (5.3%), ureteric injury in 1 pt (1.7%), and vascular injury in 1 pt (1.7%). Post-op complications included four (7.0%) infection, three (5.3%) implant related, two (3.5%) radiographic (one PJK and one DJK), one (1.7%) neurologic, one (1.7%) wound problem, and two (3.5%) sacral ulcers. IOM changes were similar in the VCR (48.7%) and non-VCR (23.5%) pts, p > 0.05. Complication rates were similar among HGT and non-HGT groups. Significant improvements from baseline were seen in the average SRS Total and domains scores and radiographic measurements for patients who attained 2-year follow-up. CONCLUSION: PVCR ± HGT can provide safe and optimal correction in cases of severe post-TB kyphosis with good clinical and radiographic outcomes in underserved regions.

Post-traumatic Vertebral Compression Fracture Treated with Minimally Invasive Biologic Vertebral Augmentation for Reconstruction.

In the United States, there is a high incidence of motor vehicle and sports injuries among the active population causing symptomatic post-traumatic vertebral compression fracture. At our institution, 28 cases of painful post-traumatic vertebral compression fractures (PPT-VCFs) were successfully treated with percutaneous vertebral augmentation (VA) for stabilization and reconstruction with intravertebral polyethylene mesh sac (OptiMesh®, Spineology, Inc., Stillwater, MN) and biological morcelized bone graft. The surgical approach provides an efficacious and controlled minimally invasive delivery mechanism to stabilize and reconstruct VCFs, as well as avoiding serious complications from Polymethylmethacrylate (PMMA) of vertebroplasty and kyphoplasty. The construct for biological bone graft/vertebral augmentation is osteoconductive and osteoinductive, and is used to create biologic vertebral stabilization and reconstruction. The adjacent vertebra integrity is protected by the construct with similar elasticity and physical characteristics of the biologic morcelized bone, more matched to that of adjacent bone than PMMA. The surgical techniques are described herein.

Innovative grid positioning system (GPS) guidance for minimally invasive spinal surgery.

Symptomatic degenerated spinal discs and spinal stenosis are common problems that can often be treated conservatively, but some require decompressive spinal surgery for relief. Traditional open spinal discectomy is associated with significant tissue trauma, higher morbidity and complication rates, a longer convalescence, and even destabilization of the spine. The trend of spinal surgery is rapidly moving toward less traumatic minimally invasive spine surgery (MISS).1,2 The problem that faces the surgeon performing endoscopic MISS is that it is done with limited surgical exposure and visualization of the surgical field. The surgical field can only be viewed through an endoscope to correlate the lesion/pathology in relationship to imaging studies aided by C-arm fluoroscopy. In response, a logical and simple Grid Positioning System (GPS) was developed to provide a precise surgical trajectory/approach for the disc lesion to undergo decompression. GPS involves 3D geometric triangulation of 3 different planes guided by fluoroscopy for introduction of surgical instruments along a geometric line toward the lesion without compromising healthy anatomical structures. This system facilitates MISS, especially in the morbidly obese. In this chapter, we will describe the GPS system and its application to aid in facilitating minimally invasive decompressive spine surgery for alleviating symptoms of degenerative spinal disease, herniated disc, and spinal stenosis, while avoiding the complications and risks of conventional more traumatic spinal surgery and fusion.

Evolving minimally invasive spine surgery: a surgeon's perspective on technological convergence and digital or control system.

Degenerated spinal disc and spinal stenosis are common problems requiring decompressive spinal surgery. Traditional open spinal discectomy is associated with significant tissue trauma, greater morbidity/complications, scarring, often longer term of convalescence, and even destabilization of the spine. Therefore, the pursuit of less traumatic minimally invasive spine surgery (MISS) began. The trend of spinal surgery is rapidly moving toward MISS. MISS is a technologically dependent surgery, and requires increased utilization of advanced endoscopic surgical instruments, imaging-video technology, and tissue modulation technology for performing spinal surgery in a digital operating room (DOR). It requires seamless connectivity and control to perform the surgical procedures in a precise and orchestrated manner. A new integrated DOR, the technological convergence and control system SurgMatix(R), was created in response to the need and to facilitate MISS with "organized control instead of organized chaos" in the endoscopic OR suite. It facilitates the performance, training, and further development of MISS.