Dynesys dynamic stabilization: less good outcome than lumbar fusion at 4-year follow-up.

Dynamic semirigid stabilization of the lumbar spine was introduced in 1994 in an attempt to overcome the drawbacks of fusion. It is supposed to preserve motion at the treated levels, while avoiding hypermobility and thus spondylosis at the adjacent levels. Although the early reports showed promising results, the long term effects are still debated. We retrospectively compared outcomes of Dynesys dynamic stabilization with those of the traditional fusion technique. Thirty-two patients who had undergone Dynesys between 2004 and 2006 (group 1) were compared to 32 patients who had been treated with fusion between 2005 and 2006 (group 2). VAS for back and leg pain, and ODI improved significantly in both groups (p < 0.001). These scores were all better in the fusion group, and even significantly so as far as VAS for back pain was concerned (p = 0.014). Similarly, more patients were satisfied or very satisfied after fusion than after Dynesys: 87.5% versus 68.8% (p = 0.04). Interestingly, in the Dynesys group scatter plot graphs showed a positive correlation between older age and improvement in the two VAS scores and in ODI. Dynamic stabilization with Dynesys remains controversial. Older patients are relatively more satisfied about it, probably because of their low level of demands.

Evaluation of Factors Delaying Discharge in Acute Orthopedic Wards: a Prospective Study.

INTRODUCTION: Prolonged hospitalization due to delayed discharge not only increases cost, it also increases the risk of medical complications e.g., hospital acquired infections. Length of stay (LOS) is one of the indicators that reflect total cost of care during hospitalization. The study was planned to evaluate the factors affecting delay in discharges from hospital and whether these factors are avoidable. HYPOTHESIS: The LOS in an acute orthopedic trauma ward is mainly determined by relative contribution patient derived factors which are present even prior to admission, rather than organisational/administrative factors. MATERIALS AND METHODS: Four hundred and fifty-three case notes were reviewed for 6 months prospectively from an acute care hospital. Information was collected on demographic profile, functional and cognitive function, past medical and social history, admitting diagnosis, discharge limiting and delaying factors. RESULTS: Out of 453 patients admitted from Jan 2005 to Jun 2005, 50 patients stayed longer than 28 days in the study group. The mean ages of the patients were 84 years (SD 4.5). The mean Abbreviated mental test score of the study was 5 (range 1-10). On admission, 78% of the patients had co-morbidities with 40% of patients having three or more associated medical problems. The two main factors limiting discharge were social issues in 33 patients (66%) and sepsis in 14 patients (28%). CONCLUSION: Older patients with co-morbidities are more prone to long stay due to de-conditioning requiring social input and nosocomial infection. The study thus proved the hypothesis and suggested that early identification of social issues and prompt discharge planning helps to avoid delay in discharge.