Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease.

Introduction: The number of reoperations increases with the growing number of operations performed. Methods: The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. Results: The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. Conclusions: Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.

Assessment of the results of occipito-cervical stabilization in cranio-vertebral damage.

Damage to the cranio-vertebral junction includes bone and ligament structures as well as the nervous system. Due to the unique structure of the occipital-atlanto-axial complex (C0-C1-C2) and biomechanical properties, they cause a surgical challenge. The aim of the surgery is to achieve bone fusion and stability of occipital-atlanto-axial complex. AIM: The aim of the study was to analyze the causes and effects of damage to the cranio-vertebral junction and the results of surgery with occipitocervical stabilization. MATERIALS AND METHODS: 43 patients who underwent occipital-cervical stabilization due to traumatic lesions in the C0-C1-C2 area were analyzed retrospectively in the 2000-2018 period in the Department of Neuroortopedia MCR STOCER. RESULTS: In 49%, the cause of trauma to the cranio-vertebral junction was a fall from a height, and it was in 37% a traffic accident. 70 % patients had C2 vertebra fracture with no stenosis of cervical canal and 14% had signs of C1-C2 instability. Politrauma was diagnosed in 9 patients and 23.3% of examined manifested neurological deficits. 70% of patients were in the 2nd group of risk according to the ASA scale. CONCLUSIONS: The analysis of damage to the cranio-vertebral junction showed that the main cause of injury was a fall. 21% patients presented tetraparesis. When qualifying patients after trauma to the craniovertebral junction for surgery, the degree of risk should be taken into account. Despite the high complication rate which was over 50 %, presented technique was effective because 95% patient achieved bone fusion and stability C0-C1-C2 complex.

Surgical treatment of thoracic disc herniation.

Symptomatic thoracic disc herniation is estimated on 1 person per million per year. 70% of all thoracic disc herniation cases are asymptomatic. This condition is often undiagnosed in regard to misguided clinical manifestations. Surgical treatment of symptomatic thoracic disc herniation is major challenge for spine surgeons because of the fact that thoracic spine has special anatomical conditions. Historically, posterior approach with laminectomy was treatment by choice, but this method was abandoned for some time, because of the high risk of postoperative complications. During last years we observe development of new approaches and advanced techniques e.g. microsurgical pedicle-sparing transfacet approach, costotransversectomy, extracavitary approach, minimal invasive thoracoscopic or endoscopic discectomy, but posterior approach is still broadly applied.

Spinal cord infarction after tumor removal surgery of the thoracic region - a case report.

Spinal cord infarction is very rare condition and usually occurs in the thoracic region of the spine. The etiology is often unknown and patophysiology can be diverse. The stroke may occur while performing a surgical procedure, but it is also found in vascular diseases, for example dissecting aneurysms, vasculitis and vascular malformations. A CASE REPORT: The authors present the case of a 62 year old woman admitted to the Neuroortopedics department due to metastasis of papillary renal carcinoma to the spine. During physical examination no neurological deficits were found. However magnetic resonance imaging revealed pathological tissue covering the left pedicle of the Th9 vertebra, penetrating the spinal canal, and compressing the spinal cord. The patient was qualified to the surgery and underwent tumor removal and transpedicular stabilization of the spine. The operation proceeded on schedule, without complications. After the operation the patient did not have any neurological deficits. In the first 24 hours post-surgery paresis of the lower limbs appeared, which rapidly deepened until the right limb was paralyzed. Due to the lack of improvement after administration of solumedrol, and suspicion of hematoma at the surgical site, the patient was qualified for reoperation. Intraoperatively there was no compression of the spinal cord, nonetheless, after being awaken from surgery, no active movements were found in the left lower limb. Magnetic resonance imaging was performed and revealed spinal cord infarction in its ventral part extending from Th9 to Th12. CONCLUSIONS: Even in procedures where no surgical complications appeared it should be noted that the rare risk of spinal cord infarction exists.

[Chirurgiczne leczenie uszkodzen polaczenia czaszkowokregoslupowego]. / Surgical treatment of damage to the cranio-vertebral junction.

Damages of the cranio-vertebral junction include bone and ligamentous structures. Due to the unique design of the C0-C1-C2 complex and biomechanical properties, they represent a major surgical challenge. Treatment of damage to this area involves decompression of nerve structures with simultaneous occipito-cervical fixation from posterior access. AIM: The aim of the study was to analyze patients operated on due to damage to the cranio-vertebral junction in 2009-2018. MATERIALS AND METHODS: Medical documentation of 78 patients was analyzed in which occipito-cervical stabilization was performed due to damages in the C0-C1-C2, in the period 2009-2018 in the Department of Neuroortopedics Mazovian Rehabilitation Center STOCER. Demographic data, ie age and sex of patients, causes of C0-C1-C2 damage, perioperative complications, duration of surgery, time of hospitalization and perioperative blood loss were assessed in the study. The operating result was evaluated based on the bone fusion obtained. RESULTS: The occipital-cervical stabilization operations constituted on average 0.96% of all spinal surgery using implants. The most common indications for surgical treatment were injuries, especially in men (35.9%) and the consequences of rheumatoid arthritis, especially in women (29.5%). There were 37 females from 29 to 77 years (mean 54+/-25) and 41 men from 21 to 71 years (mean 53+/-23). The highest number of procedures was performed without laminectomy (53.8%) and in the C1 region (38.5%). The number of observed complications after the performed procedures was lower than in the reported literature, with surgical site infections occurring in 2.6% of cases. CONCLUSIONS: Based on the analysis, it can be concluded that the accepted surgical procedure with the use of spine implants in patients with damage to the cranio-cervical junction was justified and the procedures performed correctly. A small number of complications indicates that the implemented procedure in the perioperative period is appropriate and ensures the patient's safety.

[Leczenie operacyjne zlaman zeba obrotnika z dostepu przedniego]. / Surgical treatment of the odontoid fractures from anterior approach.

The surgical treatment of the odontoid fractures is an important problem in the practice of medical teams involved in spinal surgery. There is still no consensus on dealing with fractures C2. The stabilization of the rodontoid with 1 or 2 cannulated screws (AOSF) is currently one of the options in the treatment of C2 unstable fractures since Bohler and Nakanishi introduced this method. AIM: The aim of the study was to assess the risk of complications in the early perioperative period of patients subjected to the stabilization procedure of the odontoid using AOSF. MATERIALS AND METHODS: Retrospective results of treatment of patients with odontoid fractures treated surgically with AOSF in the neuroortopedic ward in 2009-2018 were analyzed. The study also assessed the size of blood loss during surgery, the duration of surgery, the average time of hospitalization, the number of days in the ward after surgery. Perioperative complications, spinal cord injury, hematoma and wound area infection, the number of reoperations and intra- and perioperative mortality were also assessed. RESULTS: Most of the 47 patients treated with AOSF exceeded 50 years of age. The duration of the operation was on average 95 +/- 15 min. Only one patient required early reoperation on the second postoperative day due to a hematoma within the neck accompanied by dyspnea. Intra- and post-operative blood loss did not exceed 100 ml, and in 42 (89%) patients, there was no trace. There were no signs of surgical site infection. 19 patients (40%) from the operated group had additional fractures. The average time of hospitalization was 6.7 +/- 2.3 days, and the duration of stay after surgery 3.6 +/- 2.2 days. In the postoperative period, no cardiorespiratory complications were observed. CONCLUSIONS: A high safety profile of the stabilization of the odontoid was found using AOSF. Stabilization from the anterior approach enables early mobilization of the patients and shortening the time of hospital stay.

Assessment of bone union in the cervical spine after the application of a spinal cage.

Background. The aim of our study was to assess interbody bone union in the cervical spine after discectomy and the use of a spinal cage. Material and methods. The clinical material consisted of 117 patients who underwent anterior cervical discectomy and fusion with a Solis cage, packed with bone graft. The subjects were operated in the Department of Neuroorthopedics at the STOCER Rehabilitation Center in 2001-2004. The follow-up ranged from one to three years. One-level fusion was performed in 50% of these cases, two-level in 48%, and three-level in 2%; thus 177 levels were examined. Radiological evaluation included bone union and stiffness of segments without bone union. In clinical examination, pain intensity was evaluated according to the ten-point VAS score. The Neck Disability Index (IND) self- assessment questionnaire was used to evaluate the patients" quality of life. Results. Union was achieved in 90% of the operated spaces. Bone fusion occurred more frequently in multi-level spondylodesis. All the operated interbody spaces in which nonunion occurred were rigid. There was no correlation between the radiological and clinical outcomes. Conclusions. The use of a Solis cage packed with autogenic bone grafts to replace a resected intervertebral disc allows union to be obtained.