Health-related quality of life after posterolateral lumbar arthrodesis in patients seventy-five years of age and older.

STUDY DESIGN: Retrospective cohort analysis of prospectively collected data. OBJECTIVE: The purpose of this study is to report health-related quality of life (HRQOL) outcomes in patients 75 years of age and older who underwent one- to two-level instrumented posterolateral lumbar arthrodesis. SUMMARY OF BACKGROUND DATA: HRQOL measures are increasingly used to measure clinical success after spinal surgery. There is limited data available to guide the clinician caring for the growing geriatric population with degenerative lumbar spine conditions. METHODS: From a database of prospectively collected HRQOL measures in patients undergoing instrumented lumbar arthrodesis, we identified 35 patients 75 years of age and older who underwent one- or two-level instrumented posterolateral lumbar arthrodesis who had complete preoperative and 2-year postoperative data. HRQOL measures included the Oswestry Disability Index (ODI), Short Form-36 Physical Component Score (PCS) and Mental Component Score (MCS), and back and leg pain numerical rating scales. Paired sample t tests were used to compare preoperative and 2-year postoperative scores. The percentage of patients reaching previously established thresholds for Minimum Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB) were calculated. RESULTS: There were 11 men and 24 women with a mean age of 78.3 years (range 75-85). Diagnoses included stenosis (20), spondylolisthesis (12), instability (1), disc pathology (1), and scoliosis (1). Twelve patients (34%) had complications, 8 (23%) major and 4 (11%) minor. There was a statistically significant improvement in all of the HRQOL measures from preoperative to 2-years postoperative. Sixty percent (21 of 35) of the patients reached the MCID threshold for ODI, PCS, and leg pain, whereas 83% (29 of 35) reached the MCID for back pain. More than half of the patients reached the SCB threshold for leg pain (19 of 35, 54%), back pain (21 of 35, 60%), ODI (19 of 35, 54%), and PCS (21 of 35, 60%). CONCLUSIONS: Properly selected patients 75 years of age and older can achieve substantial clinical improvements, based on patient reported HRQOL measures, 2 years after one- and two-level instrumented posterolateral lumbar arthrodesis.

Traumatic pediatric pneumorachis: case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: To report on a case of traumatic pneumorachis in a child and to review the existing literature. SUMMARY OF BACKGROUND DATA: Pneumorachis, the presence of air in the spinal canal, is an extremely rare finding. It may be caused by diverse pathologies such as incidental durotomy, barotrauma, pneumothorax, and trauma. In the polytrauma patient, it may be an indication of an occult spinal fracture. METHODS: The case of a 15-year old with complete paraplegia presenting with pneumorachis is presented. RESULTS: The initial computed tomography scan showed air in the spinal canal as well as surrounding subpleural and intramuscular spaces. However, there was near normal vertebral alignment with no fractures seen. Magnetic resonance imaging taken after the patient was stabilized showed a complete transaction of the spine at T3-T4 with ligamentous injury. A posterior instrumentation and fusion was performed. CONCLUSION: In the pediatric patient presenting with neurologic deficits and pneumorachis, ligamentous injury of the spine, even in the absence of bony injury, should be suspected.