Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery.

PURPOSE: The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. METHODS: In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic spondylolisthesis (n = 28) and recurrent radiculopathy after herniated disc surgery (n = 28). Clinical outcome was assessed using the visual analogue score (VAS) and Oswestry Disability Index (ODI). Quality of life was assessed with the Euroqol-5d (EQ5D), the EQ5D VAS and the WHOQOL-BREF. RESULTS: The follow-up was 5.1 (SD 2.3) years. The decrease in VAS scores was significant and comparable in both groups. We found significantly better ODI and quality of life scores for the patients with lytic spondylolisthesis. The radiological outcome showed only one non-union, and subsidence occurred in both groups at an equal amount. CONCLUSION: The MI-PLIF technique is a safe procedure with only few complications and a high fusion rate. It was successful in both groups, but the quality of life and ODI are better in primary cases.

Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome.

STUDY DESIGN: A systematic review of the literature, pertaining surgical treatment of traumatic thoracic and lumbar spine fractures, was performed. OBJECTIVES: To provide information on surgical techniques for traumatic spine fracture management, their respective performance and complication rates, based on previously published information. SUMMARY OF BACKGROUND DATA: The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial. There is insufficient evidence in the literature to choose between the various surgical options. In absence of conclusive studies, a systematic review can be an alternative to obtain more convincing information. METHODS: Full-text papers from 1970 until 2001 were included if strict inclusion criteria were met. Five surgical subgroups were recognized: posterior short-segment (PS), posterior long-segment (PL), reports on both posterior short- and long-segment (PSL), anterior (A), and anterior combined with posterior (AP) techniques. Clearly defined and generally accepted parameters were scored and subsequently analyzed. The preoperative injury severity of the surgical groups was compared. The neurologic, radiologic, and functional outcome and complications of all groups were assessed. RESULTS: A total of 132 papers, the majority being retrospective case-series, were included representing 5,748 patients. The preoperative injury severity revealed an inequality between the subgroups. Partial neurologic deficits had the potential to resolve irrespective of treatment choice. None of the five techniques used was able to maintain the corrected kyphosis angle. The functional outcome after surgery seems to be better than generally believed. Complications are relatively rare. CONCLUSIONS: In general, surgical treatment of traumatic spine fractures is safe and effective. Surgical techniques can only be compared using randomized controlled trials.

Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm: report of two cases.

STUDY DESIGN: Two cases of lumbar vertebral erosion resulting from abdominal aortic false aneurysm are reported. OBJECTIVE: To present an uncommon complication of aortic endoprosthesis causing spinal pathology. SUMMARY OF BACKGROUND DATA: Vertebral body pathologies usually are associated with fracture, osteoporotic collapse, tumor, spondylitis, or spondylodiscitis. Aortic abdominal aneurysm rarely has been reported as causing lytic lesions of the spine. METHODS: A retrospective case analysis was performed for two patients with an aorta bifurcation prosthesis and lytic lesions of the spine. False aneurysms were detected at the proximal junction of the prostheses. A biopsy of the affected vertebrae showed no infection or malignancy. Surgery was performed in both cases, and the prostheses were successfully revised. In one case, an anteroposterior spinal fusion was performed because of severe anterior bone loss. RESULTS: The back pain of both patients resolved completely after surgery. In one of the patients, an embolectomy in the right leg failed, and a below-the-knee amputation had to be performed. CONCLUSIONS: In patients with endovascular prostheses, false aneurysm should be considered when lytic lesions of vertebral bodies are differentially diagnosed because these patients can present with only spinal symptoms.

Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI.

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.

Long-term clinical results of cemented revision of primary cemented total hip arthroplasties.

Seventy-six patients who had undergone revision of a cemented total hip replacement were reviewed with an average follow-up of almost ten years. The average age at primary total hip replacement (PTHR) was 63.3 years. The average time between primary total hip replacement and revision was 62.5 months. Revision surgery was performed without using special techniques such as acetabulum reconstruction or femoral bone grafting. We evaluated patients pre- and postoperatively using the Merle d'Aubigné-Postel(M d'A) hip score. Clinically we observed an improvement of the hip score after total hip revision, particularly regarding pain. Thirty hips required a second, and six a third revision. If re-revision is used as an end-point, our results are unsatisfactory, as we had a cumulative failure rate of 54% after 12 years. This is mainly due to not using special techniques adapted to revision situations.