A one-session circumferential reconstruction in thoracic and lumbar spine fractures using a small expandable cage.

AIM: Circumferential reconstruction of thoracic and lumbar vertebrae is most frequently performed in two sessions. The authors assessed feasibility, safety and results of a surgical technique in which the use of a small cage allows a less invasive strategy. In addition, since the authors perform urgent decompression in specific cases of spinal cord injury, feasibility of this technique in emergency was verified. METHODS: In two Neurosurgical Departments, between May 2001 and May 2006, 62 patients with thoracic or lumbar fractures were operated on using this technique. X-rays were performed postoperatively and around 45 days from surgery. Three-dimension-computed tomography (3D-CT) scans were performed at 3, 6 and 12 months. Neurological evaluations were repeated at every outpatient visit. After screw insertion at the adjacent levels and traditional transpedicular circumferential decompression, further bone is removed to excavate a niche in the vertebral body and the contiguous discs are removed. The expandable cage, filled with bone fragments, is inserted horizontal or oblique laterally to the sac and applied vertical inside that niche and then expanded. The circumferential stabilization is completed with bone grafting and posterior instrumentation. RESULTS: 3D-CT scans showed sound fusion and no manifest correction loss. Nineteen patients improved at least one grade in the ASIA scale and 11 gained neuromeric levels. CONCLUSION: This technique, fairly undemanding and feasible also in emergency, proved to be safe and resistant. Two-year follow-up demonstrated thriving fusion and steady alignment. It is a valuable surgical therapy to selected cases of burst fracture.

Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients.

BACKGROUND: Autologous anterior iliac crest bone graft is still widely considered the gold standard for anterior cervical fusion after discectomy or corporectomy. Postoperative pain at the donor site is one of the main disadvantages to this technique. This prospective study aimed to evaluate pain at the donor site, after careful, standardised bone harvesting. METHODS: From March 2003 to March 2004, a prospective study was performed in a single neurosurgical department on 50 patients who underwent anterior iliac crest bone harvesting using a standard and careful surgical technique. During a one year follow-up, patient donor site pain was assessed with a Visual Analogous Scale (VAS) at 2, 7 and 60 days from surgery and finally, by a telephone interview, at one year. FINDINGS: The duration of time in hospital ranged from 4 to 9 days. On the 2(nd) day after surgery, pain, according to the VAS score, was recorded as being >7 by 4 patients (8%), 5-7/10 by 27 patients and >5/10 in 19 cases. On the 7(th) day after surgery, none of the patients reported any VAS > 7, 1 patient's VAS score was 6/10 and 49 patients had a VAS < 5. At 2 month follow-up, 45 patients were completely without pain (VAS 0) and the remaining 5 had a VAS < 5. At one year, 46 patients reported no pain (one patient was lost to follow-up); three continued to have pain <5 in VAS scale. CONCLUSIONS: After harvesting of bone from the iliac crest, using a standardised approach based on anatomised principles, most patients do not experience persisting pain at the donor site.

Posterior lumbar interbody fusion with peek cages: personal experience with 20 patients.

AIM: The use of interbody cages to obtain fusion in the lumbar spine has increased noticeably in the last few years. They are used both with and without posterior stabilization. In our institution a prospective analysis to determine whether PEEK cages can be used as a stand alone device has been performed. METHODS: The 20 patients with PEEK cages had clinical and radiological follow-up with controls at 1, 3, 6 and 9 months. RESULTS: The clinical results were considered satisfactory in 75% of the cases. There were no intra-or perioperative complications. There was no displacement of the cages. No signs of unsuccessful fusion were observed. CONCLUSIONS: Interbody PEEK cages fulfill the objective of stabilizing the treated segment immediately and subsequently. They can be used as stand alone devices with the correct surgical technique and following precise indications.