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Study design: Technical note. Purpose: To provide a technical description of the placement of Gardner-Wells tongs and the performance of awake cranio-cervical traction to reduce AO type C injuries of the sub-axial cervical spine with Gardner-Wells tongs. Methods: In this technical note, the authors present the indications, the contraindications, the pull-out of the pins, a detailed description of the technique for its proper placement, traction reduction technique, reduction maneuvers, complications and post-reduction care. Results: Awake reduction of AO type C injuries of the sub-axial cervical spine can be successfully performed using Gardner-Wells tongs. Conclusions: There is sufficient evidence to recommend the use of cranio-cervical traction in these vertebral injuries; however, we lack a detailed technical note to guide its proper placement.
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Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery - 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a "consensus technique." Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.
RESUMO
OBJETIVO: Evaluar a un año el resultado del uso de espaciadores dinámicos en listésis grado I de Meyerding utilizando la escala de incapacidad de Oswestry. MÉTODOS: Se revisa el historial electrónico y radiográfico de los pacientes según criterios en el período de enero 2008 a diciembre 2010, con el propósito de realizar un estudio de cohortes, retrospectivo, longitudinal y observacional. RESULTADOS: El Oswestry prequirúrgico fue de 3.4% leve, 55.2% moderado y 41.4% severo; mientras que el posquirúrgico fue de 79.3% leve y 20.7% moderado. La cirugía realizada más común fue exploración y liberación con un 72.4%, presentando discectomía únicamente el 27.6%. Los pacientes presentaron dolor irradiado a miembro pélvico derecho en el 37.9%, miembro pélvico izquierdo 44.8% y a ambos miembros pélvicos en un 17.2%. Se presentó dolor posquirúrgico irradiado a miembro pélvico únicamente en el 2.4% siendo que el 100% de los casos presentaron algún tipo de dolor irradiado. Se utilizó espaciador DIAM en 79.3% y Wallis en 20.7% CONCLUSIONES: El tratamiento con espaciador interespinoso presenta un bajo índice de reintervención y por lo menos a un año presenta mejoría significativa en el índice de incapacidad.
OBJETIVO: Avaliar o resultado em ano do uso de espaçadores dinâmicos em listese de grau I de Meyerding, utilizando a escala de incapacidade de Oswestry. MÉTODOS: Foi revisado o prontuário eletrônico e as radiografias dos pacientes, de acordo com os critérios, no período de janeiro de 2008 a dezembro de 2010, visando realizar um estudo de coortes, retrospectivo, longitudinal e observacional. RESULTADOS: O índice de Oswestry pré-cirúrgico foi de 3,4% leves, 55,2% moderados e 41,4% graves, enquanto o pós-cirúrgico foi de 79,3% leves e 20,7% moderados. A cirurgia mais realizada foi exploração e liberação, em 72,4%, sendo que 27,6% apresentaram apenas discectomia. Os pacientes tinham dor irradiada para o membro inferior direito em 37.9%, para o membro inferior esquerdo em 44,8% e para ambos os membros inferiores, em 17,2%. Verificou-se dor pós-operatória irradiada para o membro inferior só em 2,4%, sendo que 100% dos casos tinham algum tipo de dor irradiada. Foi empregado o espaçador DIAM em 79.3% e o Wallis em 20.7% CONCLUSÕES: O tratamento com espaçador interespinhoso apresenta baixo índice de re-intervenção e pelo menos em um ano, apresenta melhora significante do índice de incapacidade.
OBJECTIVE: To evaluate one-year results of using dynamic spacers in listhesis grade I of Meyerding using Oswestry Disability Index. METHODS: The disability scale review was based in the electronic and radiographic history of patients according to criteria in the period from January 2008 to December 2010, in order to conduct a cohort study, retrospective, longitudinal, and observational. RESULTS: The Oswestry index before surgery was 3.4% mild, 55.2% moderate and severe 41.4%, while the postoperative was 79.3% mild and 20.7% moderate. The most common surgery performed was exploration and release in 72.4%, and only 27.6% had discectomy. Patients had pain radiating to right lower limb in 37.9%, to the left lower limb in 44.8% and to both lower extremities in 17.2%. Pain radiating to the lower limb after surgery was found only in 2.4%, and 100% of the cases had some type of radiating pain. The DIAM interspinous implant was used in 79.3%, and the Wallis in 20.7%. CONCLUSIONS: Treatment with interspinous spacer has a low rate of reoperation and at least during one year presented significant improvement in the rate of disability.
