Anterior interbody grafting and instrumentation for advanced spondylodiscitis.

OBJECTIVE: To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis in patients who had failed medical management. METHODS: A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. RESULTS: There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from 3.78+/-0.78 preoperatively to 4.78+/-0.35 at final follow up and mean VAS score was improved from 7.43+/-0.54 to 2.07+/-1.12. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. CONCLUSION: According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.

Inter-racial, gender and aging influences in the length of anterior commissure-posterior commissure line.

OBJECTIVE: The length of anterior-posterior commissure (AC-PC) in racial groups, age, gender of patients with deep brain stimulation (DBS) and pallidotomy were investigated. METHODS: From January 1996 to December 2003, 211 patients were treated with DBS and pallidotomy. There were 160 (76%) Caucasians, 35 (17%) Hispanics, 12 (5%) Asians and 4 Blacks (2%). There were 88 males and 52 females in DBS-surgery group and 44 males, 27 females in pallidotomy group. Mean age was 58 year-old. There were 19 males and 19 females and mean age was 54.7 years in the control group. Measurements were made on MRI and @Target software. RESULTS: The average AC-PC distance was 24.89 mm (range 32 to 19), which increased with aging until 75 years old in Caucasian and also increased with aging in Hispanic, but the AC-PC distance peaked at 45 years old in Hispanic. The order of AC-PC distance were 25.2+/-2 mm in Caucasian, 24.6+/-2.24 mm in Asian, 24.53 mm in Black, 23.6+/-1.98 mm in Hispanic. The average AC-PC distance in all groups was 24.22 mm in female who was mean age of 56.35, 25.28 mm in male who was mean age of 60.19 and 24.5+/-2 mm in control group that was excluded because of the difference of thickness of slice. According to multiple regression analysis, the AC-PC distance was significantly correlated with age, race, and gender. CONCLUSION: The AC-PC distance is significantly correlated with age, gender, and race. The atlas of functional stereotaxis would be depended on the variation of indivisual brain that can influenced by aging, gender, and race.

Outcome and efficacy of height gain and sagittal alignment after kyphoplasty of osteoporotic vertebral compression fractures.

OBJECTIVE: Although a significant correction of local kyphosis has been reported previously, only a few studies have investigated whether this correction leads to an improved overall sagittal alignment. The study objective was to determine whether an improvement in the local kyphotic angle improves the overall sagittal alignment. We examined and compared the effects of thoracic and lumbar level kyphoplasty procedures on local versus overall sagittal alignment of the spine. METHODS: Thirty-eight patients with osteoporotic vertebral compression fractures who showed poor response to conventional, palliative medical therapy underwent single-level kyphoplasty. The pertinent clinical data of these patients, from June 2006 to November 2006, were reviewed retrospectively. We measured preoperative and postoperative vertebral body heights, which were classified as anterior, middle, or posterior fractured vertebral body heights. Furthermore, the local and overall sagittal angles after polymethylmethacrylate deposition were measured. RESULTS: More height was gained at the thoracic level, and the middle vertebral height regained the most. A significant local kyphosis correction was observed at the fractured level, and the correction at larger spanning segments decreased with the distance from the fractured level. CONCLUSION: The inflatable balloon kyphoplasty procedure was the most effective in regaining the height of the thoracic fractured vertebra in the middle vertebral body. The kyphosis correction by kyphoplasty was mainly achieved in the fractured vertebral body. Sagittal angular correction decreased with an increase in the distance from the fractured vertebra. No significant improvement was observed in the overall sagittal alignment after kyphoplasty. Further studies in a larger population are required to clarify this issue.