Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease.

Introduction: The number of reoperations increases with the growing number of operations performed. Methods: The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. Results: The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. Conclusions: Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.

Evaluation of the results of posterior approach in thoracic disc herniation surgery.

The incidence of symptomatic intervertebral disc hernias in the thoracic segment is estimated at 1 case per million people per year, which is about 0.25-0.75% of all symptomatic intervertebral disc hernias and 0.15-1.85% of operative intervertebral disc diseases. AIM: The aim of the study was to assess the results of the surgical treatment of symptomatic discopathy in the thoracic spine through the posterior approach. MATERIALS AND METHODS: The results of the surgical treatment of 52 patients (35 women, 17 men) with symptomatic thoracic disc herniation in the Department of Neuroorthopedics in the years 2012-2019 were analyzed retrospectively. The neurological and functional status of patients before and after the surgery was assessed, as well as the average duration of the surgery and hospitalization, perioperative complications, intraoperative blood loss and the number of reoperations. Radiculopathy and myelopathy were the main indications for surgery. RESULTS: The largest group included patients operated on in the 5th and 6th decades of life, with women being the majority (67%). Hernia of the distal thoracic spine, i.e. Th10-Th11-Th12-L1, was most often operated on. According to the Frankel scale, the largest number of patients (47 before the surgery and 48 after the surgery) were qualified for groups D and E. As regards the WISCI scale the largest group of patients was classified as level 20. The rate of complications was 7%, the rate of neurological complications was 5.2% and the rate of reoperations was 3.5%. CONCLUSIONS: The vast majority of discopathies in the thoracic spine occur at lower levels, i.e. Th10-Th11-Th12-L1. The analysis of the functional status after the surgery of thoracic discopathy based on 2 scales showed a greater usefulness of the WISCI scale than the Frankel scale. A larger number of patients changed the group after surgery in the WISCI scale than in the Frankel scale. Therefore, we can conclude that the WISCI scale is more accurate in assessing the functional state of patients operated on due to thoracic discopathy.

Shoulder dislocation - analysis of cases and neurological complications.

Shoulder dislocation, i.e. loss of connection between the head of humerus and the glenoid cavity, is diagnosed in 15-25 patients per 100,000 people per year. The treatment consists, regardless of the methods, of repositioning as soon as possible i.e. restoring the correct position of the head in relation to the glenoid cavity. Some cases of dislocation, due to anatomical relations, may be complicated by damage to the brachial plexus branches. AIM: The aim of this study is to present epidemiological data, treatment methods and neurological complications in patients with diagnosed shoulder joint dislocation at the Mazovian Rehabilitation Center STOCER. MATERIALS AND METHODS: The basis for the analysis was a sample of 53795 patients, out of whom 424 patients were identified as having shoulder dislocation in the period 01.01.2015 - 31.12.2019. The examined group of patients was divided to the implemented therapeutic management, including neurological complications. RESULTS: 424 patients with diagnosed shoulder dislocation were analyzed. 217 patients required admission to the Trauma and Orthopedic Surgery Department. There was a statistically significant correlation between the occurrence of the dislocation and the gender and age of the patient. The reason for hospitalization was inability to reposition in Emergency Department (ED) conditions. Neurological complications presented 4.24% of patients with shoulder dislocation before reduction. The median time of hospitalization in the Trauma and Orthopedic Surgery Department was 1 day. CONCLUSIONS: None of the cases of successful repositioning in the ED required hospitalization due to neurological complications related to the dislocation repositioning. None of nerve impingement nor increasing of neurological complication related to shoulder repositioning apeared.

Analysis of neurological symptoms and mechanisms in dislocation, sprains and strains of joints and ligaments at neck level.

Spinal injuries can be divided into contusions, sprains of intervertebral joints, their dislocation and also damage to ligaments and muscles attachment, and fractures. Typical injuries of the cervical spine include trauma caused by a rapid hyperextension of the neck with the following hyperflexion, often referred to as "whiplash" injury, mostly as a result of traffic accidents. The annual incidence is estimated to be up to 600 per 100 000 inhabitants of Western Europe and North America. The most frequent sprain and strain injuries concerns patients aged 21-60 years. The clinical picture in the course of whiplash injury can be miscellaneous. The most frequent accompanying symptoms are neck pain with restricted mobility, headache and neurological symptoms. AIM: The aim of the study was to analyze the mechanisms of trauma, possible complications and analysis of physical examination in patients after cervical sprains, strains and dislocations treated in Mazovian Rehabilitation Center STOCER. MATERIALS AND METHODS: The basis for the analysis was a database of 10 587 traumatic patients who reported to the Emergency Department (ED) of the Mazovian Rehabilitation Center STOCER from 1 January 2017 to 31 December 2017. 340 patients with whiplash injury of the cervical spine depending on the mechanism of trauma were selected from the database. Patients with accompanied by atlantoaxial complex injuries were excluded. In summary 307 patients were included to the analysis. The examined group of patients was divided according to the therapeutic management, including neurological complications. RESULTS: We analyzed 307 patients with cervical trauma. 24 patients required admission to the Neuroortopaedic Department. 22 patients underwent surgical treatment. There was a significant correlation between cervical sprains and age of the patient. The indications for hospitalization was spine instability complicated by spinal dislocation or subluxation. Neurological complications were presented in 6.84% of patients with cervical sprains. CONCLUSIONS: Patients with cervical sprains injuries represent 3.21% of all patients reporting for ED. They also represent 8% of all traumatic admissions to the Neuroortopedic Department. Cervical sprains affect a similar percentage of women (48.21%) and men (51.79%). The most common causes are those related to traffic accidents. 71.34% of cases are drivers or passengers involved in such an accident. Neurological symptoms are found in 6.84% of patients with cervical sprains. No new neurological symptoms have appeared in any patient since admission to the ED or Neuroortopaedic Department. Axial compression is not diagnostic for cervical sprains and does not correlate with the severity of injury.

Post-traumatic bilateral scapular and thoracic vertebral body fractures - a case report.

The simultaneous fracture of both scapulae with coexisting fracture of the thoracic vertebral body is observed extremely rarely and is fully dependent on the mechanism that caused them. A CASE REPORT: The 59-year-old patient was admitted to the trauma and orthopedic department because of back pain and the inability to move independently. A few hours earlier he suffered bludgeoning trauma from a thick branch falling from a tree. During the physical examination significant limitation the range of motion in shoulder joints with was found. <15 ° flexion and <30 ° abduction, with limited external rotation in the right shoulder joint, and <15 ° flexion and <15 ° abduction, with significant external rotation deficiency. Normal range of motion in both hands was preserved. No sensory deficits or paresis were observed. Radiographic examination revealed the presence of a multifragmentary fracture of both scapulae and a fracture of the Th9 vertebral body, which was confirmed by computed tomography of the chest. The patient was qualified for conservative treatment of scapular fractures and was fitted with an abduction splint for the left shoulder. The Th9 vertebral body required surgical approach. The patient underwent transpedicular stabilization of the Th7,8,9,10 vertebrae with precontoured rods for the kyphotic deformation of the spine. After the procedure, the patient was provided with Javette's brace strengthening the spine correction and discharged for further outpatient observation. CONCLUSIONS: Fracture of the scapula is one of the most demanding fractures to diagnose in the classic radiological examination. CT scans with 3D reconstruction can be considered to be the "gold standard". Surgical procedures is indicated for patients with severe comminution of fracture fragments and neurological symptoms. Minor fracture displacements can be conservatively treated. Coexisting Th9 vertebra fracture in this case required surgery by posterior transpedicular stabilization.