Split laminotomy versus conventional laminotomy: postoperative outcomes in pediatric patients.

OBJECTIVE Split laminotomy is a technique for accessing the spinal canal from the posterior midline that minimizes muscle dissection and bone removal. Benefits of this approach in minimizing postoperative pain and muscle atrophy in the adult population have been reported, but pediatric data are limited. Herein, the authors evaluate the benefits of the split laminotomy technique in pediatric patients. METHODS Data obtained in patients who underwent posterior spine surgery at Children's Hospital of Wisconsin for an intradural midline pathology between April 2008 and June 2015 were reviewed retrospectively. Each patient was assigned to one of two groups, the split-laminotomy or conventional-laminotomy group. The primary outcomes assessed were mean daily pain score, total opioid use over a period of 72 hours after surgery, and the degree of paraspinal muscle atrophy and fat infiltration found on short-term (1-4 months) and long-term (1-4 years) follow-up spine MRI studies. RESULTS A total of 117 patients underwent lumbar-level surgery (83 conventional laminotomy, 34 split laminotomy), and 8 patients underwent thoracic-level surgery (4 in each group). No significant difference in the mean daily pain scores between groups was found. The daily opioid use was significantly lower in the split-laminotomy group on postoperative day 0 (POD0) and POD1 but not on POD2 (p = 0.01, 0.01, and 0.10, respectively). The total opioid use over the 72-hour postoperative period was significantly lower in the split-laminotomy group (p = 0.0008). The fat/muscle ratio was significantly higher in both the short-term and long-term follow-up periods in the conventional-laminotomy group (p = 0.01 and 0.0002, respectively). The rate of change of paraspinal muscle fat infiltration was significantly lower in the split-laminotomy group than in the conventional-laminotomy group (p = 0.007). The incidence of complications was not significantly different between groups (p = 0.08). CONCLUSIONS This study was of the largest series reported thus far of pediatric patients who underwent split laminotomy and the only controlled study that has involved children. The authors' results reinforce the short-term benefit of split laminotomy in minimizing acute postoperative pain and long-term benefits of decreasing muscle atrophy and fatty degeneration, which are known to be associated with the development of chronic pain and spinal instability. Additional efforts for assessing long-term effects in the development of chronic pain, spinal instability, and spinal deformity are still necessary.

Utility of a combined current procedural terminology and International Classification of Diseases, Ninth Revision, Clinical Modification code algorithm in classifying cervical spine surgery for degenerative changes.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the sensitivity and specificity of a combined Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) algorithm in defining cervical spine surgery in comparison to patient operative reports in the medical record. SUMMARY OF BACKGROUND DATA: Epidemiological studies of spine surgery often use ICD-9-CM billing codes in administrative databases to study trends and outcome of surgery. However, ICD-9-CM codes do not clearly identify specific surgical factors that may be related to outcome, such as instrumentation or number of levels treated. Previous studies have not investigated the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm for defining cervical spine surgical procedures. METHODS: We performed a retrospective study comparing the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm to the operative note, the gold standard, in a single academic center. We also compared the accuracy of our combined algorithm with our published ICD-9-CM-only algorithm. RESULTS: The combined algorithm has high sensitivity and specificity for defining cervical spine surgery, specific surgical procedures such as discectomy and fusion, and surgical approach. Compared to the ICD-9-CM-only algorithm, the combined algorithm significantly improves identification of discectomy, laminectomy, and fusion procedures and allows identification of specific procedures such as laminaplasty and instrumentation with high sensitivity and specificity. Identification of reoperations has low sensitivity and specificity, but identification of number of levels instrumented, fused, and decompressed has high specificity. CONCLUSION: The use of our combined CPT and ICD-9-CM algorithm to identify cervical spine surgery was highly sensitive and specific. For categories such as surgical approach, accuracy of our combined algorithm was similar to that of our ICD-9-CM-only algorithm. However, the combined algorithm improves sensitivity, and allows identification of procedures not defined by ICD-9-CM procedure codes, and number of levels instrumented and decompressed. The combined algorithm better defines cervical spine surgery and specific factors that may impact outcome and cost.

Empiema epidural espinal. Análisis de 14 casos / Spinal epidural empiema. Analysis of 14 cases

Objetivos. Realizar un estudio sobre los casos de empiema epidural espinal atendidos en los últimos 20 años y practicar una revisión de la literatura sobre la patogenia, diagnóstico y tratamiento de estas lesiones. Pacientes y métodos. Se trata de un estudio retrospectivo descriptivo sobre 14 casos de empiemas epidurales espinales. Se analizaron las características epidemiológicas básicas, manifestaciones clínicas, datos analíticos, técnicas de diagnostico, actitudes terapéuticas usadas y los resultados obtenidos. Resultados. La serie esta formada por 7 varones y 7 mujeres con edades que oscilaron entre 8 y 76 años (media 48.9). En 12 casos el síntoma de presentación fue la presencia de dolor vertebral local, siempre en relación con la localización del empiema, siendo la duración media de la sintomatología de 9.3 días. La velocidad de sedimentación globular (VSG) estaba elevada en todos los casos y existía leucocitosis en trece paicentes (92,9%). En 11 casos (78,5%), la localización del empiema fue en la región dorsal. Trece pacientes fueron tratados mediante cirugía y uno recibió exclusivamente tratamiento antibiótico. Conclusiones: En paicentes con factores de riesgo (inmunosupresión, diabestes), la presencia de dolor espinal asociado a fiebre y alteraciones analíticas (leucocitosis / elevación de la VSG), deben ser con resonancia magnética espinal, ante el riesgo de desarrollar un empiema epidural. El tratamiento exclusivamente médico debe sólo reservarse para pacientes con elevado riesgo quirúrgico o que no presenten afectación neurológica (AU)

Objective. The goal of this study was to review our series of spinal epidural empiema diagnosed in the last 20 years and review the literatura regarding the pathogenesis, diagnosis and treatment of these lesions. Patints and methods. This is a retrospective study over 14 patients diagnosed of spinal epidural empyema. We review the epidemiological data, clinical symptoms, laboratory and imaging data, the treatment regimen and the results. Results. Fourteen patients, 7 males and 7 females, with an age range form 8 to 76 years (mean 48.9) were identified. The first symptom was localized back/neck pain in 12 patients and the mean duration of symptoms was 9.3 days. Erythrocyte sedimentation rate (ESR) was elevated in 13 cases (92,9%). Site of sipinal epidural empyemas was distributed along the axis but in 11 cases the location was thoracic. Thirteen patients had surgery for debridement and spinal decompression and one patient was treated successfully with antibiotics alone. Conclusions: Patients with localized back pain and fever who are at risk for developing such empyemas with elevation of white blood cells and increased ESR, should have an immediate magnetic resonance imaging sean. Urgent surgical drainage and antibiotic use are the treatment of choice in order to prevent irreversible neurological deficits. Nonsurgical treatment should be reserved for poor surgical candidates and patients without neurological deficits (AU)

Comentario al trabajo, Empiema epidural espinal. Análisis de 14 casos de M. Gelabert-González y cols / No disponible

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Laminectomía / Laminectomy

El caso del paciente con una afección de la columna proporciona las bases para esbozar un plan de cuidados de enfermería centrado en el operado de laminectomía

Laminectomía / Laminectomy

El caso del paciente con una afección de la columna proporciona las bases para esbozar un plan de cuidados de enfermería centrado en el operado de laminectomía (AU)

Fenestración subarticular multinivel en las estenosis del canal espinal. Comunicación preliminar / Subarticular multilevel fenestration in the stenosis of the spinal canal: Preliminary communication

Es bien sabido que las amplias laminectomías en las raquiestenosis pueden producir inestabilidad espinal futura; la técnica ya conocida como fenestración subarticular toma en cuenta dicha inestabilidad y produce las descomprensiones adecuadas en los verdaderos niveles existentes, tales como el nivel inter-espacio y las estenosis del canal radicular, preservando el tercio superior de las láminas, las apófisis espinosas y sus ligamentos. En caso de inestabilidad presente, se une esta técnica a los implantes tipo Cotrel Dobousset (C-D), Roy-Camille y otros. Presentamos ocho casos con dicha técnica