Use of a postoperative lumbar corset after lumbar spinal arthrodesis for degenerative conditions of the spine. A prospective randomized trial.

BACKGROUND: Lumbosacral corsets and braces have been used to treat a variety of spinal disorders. Although their use after lumbar arthrodesis for degenerative conditions has been reported, there is a lack of evidence on which to base guidelines on their use. The purpose of this study was to evaluate the effect of a postoperative corset on the outcome of lumbar arthrodesis. METHODS: A prospective randomized trial was performed in which patients who wore a postoperative lumbar corset for eight weeks full-time after a posterior lumbar arthrodesis for a degenerative spinal condition were compared with those who did not use a corset after such an operation. Ninety patients were randomized to one of the two treatments. A history was recorded and patients were assessed with a physical examination, radiographs, and functional outcome questionnaires (the Dallas Pain Questionnaire [DPQ] and the Short Form-36 [SF-36]) preoperatively and at one year and two years following the surgery. The primary outcome measure of the study was the DPQ, a disease-specific patient-derived functional measure of the spine, and secondary end points included the SF-36 scores, complications, rates of fusion as determined radiographically, and reoperation rates. RESULTS: Follow-up analysis was performed for seventy-two patients, thirty-seven randomized to the brace (experimental) group and thirty-five randomized to the control group. Regardless of the treatment method, the patients had substantial improvement in the disease-specific and general health measures by two years postoperatively. At two years, there was no difference in the DPQ category scores (the primary outcome parameter) of the two treatment groups. There was also no difference in the mean SF-36 component scores at two years. Postoperative complications occurred in 22% and 23% of patients in the experimental and control groups, respectively, and a subsequent lumbar spinal operation was performed in 19% and 14%, respectively. Seven patients (five in the experimental group and two in the control group) with radiographic evidence of nonunion underwent revision surgery. CONCLUSIONS: This study does not indicate a significant advantage or disadvantage to the use of a postoperative lumbar corset following spinal arthrodesis for degenerative conditions of the lumbar spine. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Submuscular Isola rod with or without limited apical fusion in the management of severe spinal deformities in young children: preliminary report.

STUDY DESIGN: Retrospective review of the results of submuscular rod placement with and without limited apical fusion for the treatment of severe spinal deformities in young children. OBJECTIVES: To determine the success of this method for controlling severe deformities while allowing for spinal growth and to compare this method with previously reported results. SUMMARY OF BACKGROUND DATA: A variety of methods for controlling scoliosis in young children have been reported, but complications including spontaneous fusion, loss of correction, instrumentation failure, and limited spinal growth are common. METHODS: The cases of 29 young children with progressive scoliosis or kyphoscoliosis as a result of a variety of diagnoses treated with a submuscular Isola rod and a postoperative orthosis were retrospectively reviewed. Eleven patients also had a short anterior and posterior apical fusion or convex hemiepiphysiodesis to aid in correction and stabilization of their deformity. The remaining 18 patients had a submuscular rod only. RESULTS: The mean age at surgery was 6.7 years (range, 1-11 years). The initial preoperative mean magnitude of the major curve was 66 degrees (range, 42-112 degrees ). After surgery this decreased to a mean of 38 degrees (range, 16-70 degrees ). The most recent radiographs demonstrated a mean 47 degrees curve (range, 28-79 degrees ). The mean number of lengthenings per patient has been two (range, 0-5). Nine patients have reached a suitable age and have been converted to a posterior spinal fusion and segmental spinal instrumentation. Nine complications have occurred in seven patients (24%). These included five hook displacements and three rod breakages. These were treated by hook reinsertion and rod exchange or sleeve and a repeat lengthening. There was one superficial infection treated medically. CONCLUSION: This technique is useful in the management of severe spinal deformities in young children who have either failed, or have a contraindication to, orthotic management. Complications are relatively frequent but well tolerated.

The Effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study.

STUDY DESIGN: A prospective study evaluating the efficacy of epsilon-aminocaproic acid (EACA) in decreasing perioperative blood loss in idiopathic scoliosis. OBJECTIVES: To compare the perioperative blood loss and need for blood replacement in two groups of patients undergoing surgery for idiopathic scoliosis. One group received intraoperative EACA; the other did not and served as controls. SUMMARY OF BACKGROUND DATA: Excessive blood loss increases the operative time, risk for blood product disease transmission, postoperative complications, and costs associated with posterior spinal fusion and instrumentation. EACA is an antifibrinolytic agent that has been shown to be effective in reducing perioperative blood loss during pediatric cardiothoracic surgical procedures. We hypothesized that it would also be effective in lowering blood loss during posterior spinal fusion for idiopathic scoliosis. METHODS: We compared the perioperative blood loss of 28 consecutive pediatric patients with idiopathic scoliosis who underwent posterior spinal fusion and received intraoperative EACA with 31 consecutive patients who did not receive this medication and served as a control group. RESULTS: The patients in both groups were similar. Patients in the EACA group demonstrated statistically significant decreases in total estimated perioperative blood loss and the need for autologous blood transfusion. The patients in the EACA group had no intraoperative or postoperative complications related to the use of this medication. CONCLUSIONS: Based on these preliminary findings, we believe that EACA is helpful in decreasing blood loss in patients undergoing posterior spinal fusion and instrumentation, and may decrease the number of autologous units needed to maintain safe perioperative hemoglobin levels, thereby improving safety and lowering cost associated with scoliosis surgery.