RESUMEN
INTRODUCTION: Posterior dynamic stabilisation (PDS) aims at relieving lumbar discogenic pain and preserving adjacent levels from accelerated degeneration. PURPOSE: To evaluate the results of a novel PDS system in 32 adult patients affected by chronic low back pain (CLBP) due to degenerative lumbar spine instability (DLSI). METHOD: A progressive follow-up for 12 months of 32 patients, with collection of complete clinical (ODI and VAS back + leg) and radiological data (resting + functional radiographs and MRI). RESULTS: Mean ODI scores improved from 49 to 6%, VAS back from 5 to 1 and VAS leg from 7 to 2. Twenty-two patients underwent fusion of a lower lumbar segment and stabilisation of an upper segment (hybrid fusion) whereas ten underwent dynamic stabilisation. In 16/32 patients, decompression was added to treat radicular pain. Motion in non-fused instrumented levels was unrestricted on functional X-rays and MRIs did not show significant morphologic changes. Four patients (12.5%) had unchanged functional and pain scores while two (6.3%) suffered worsening low back pain necessitating implant removal and spinal fusion. No infection, no new neurologic deficit or implant failure was recorded. CONCLUSIONS: The 1 year follow-up shows that the tested PDS system is able to provide a significant improvement in pain and disability scores when applied to patients affected by DLSI. The system does not provide better clinical results when compared to similar trials on posterior fusion. Further follow-up is ongoing to investigate the potential preservation of adjacent levels from accelerated degeneration.
Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Estudios de Cohortes , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/diagnóstico por imagen , Inestabilidad de la Articulación/complicaciones , Inestabilidad de la Articulación/diagnóstico por imagen , Dolor de la Región Lumbar/epidemiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Resultado del TratamientoRESUMEN
Direct repair of spondylolisthesis can save a functional segment in young patients with slight slipping. Since 1968 many surgeons have proposed different technical solutions to obtain the isthmic repair. Their results changed according to the technique used, the extent of listhesis and the age of the patient. The aim of our study was to perform a retrospective review on the long-term results of the direct repair of spondylolisthesis, according to the different techniques used. We operated 62 patients for isthmic repair, with three different techniques, from 1994 to 2007. We analysed the clinical and radiographic results of 52 cases, with an average follow-up of 9 ± 3 years (range 2-15). Ten patients were lost to the follow-up. The results were different depending on the technique used. Good or excellent clinical outcome by Odom's criteria were observed in the 83.3% of patients operated with the modified Scott technique. These results are better than those obtained in the group of patients operated with the Scott (62.5%) and the Buck technique (28.5%). Patients with clinical and radiological failure, who then underwent spinal fusion, were 57% with the Buck technique, 12.5% with the Scott technique and 2.7% with the Scott modified technique. The reasons for a new operation were symptomatic pseudarthrosis and progression of slipping. In conclusion, the pars defect repair is a helpful technique in lumbar spondylolisthesis, especially in young patient with slight slipping and painful symptoms resistant to conservative treatment. In our experience, the modified Scott technique seems to provide a better outcome than the Scott and Buck techniques.
Asunto(s)
Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/diagnóstico por imagen , Masculino , Selección de Paciente , Posición Prona , Radiografía , Estudios Retrospectivos , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Forty-two patients underwent surgery for far-lateral disc herniations. Average patient age was 45.1 years, 28 patients were male and 14 female. The level concerned most was L4-5 disc (55%). A paramedian muscle-splitting intertransverse approach is described for this type of disc herniation. This method allows direct visualization of the disc and root involved and does not provide bone resection and important surgical manipulation. Ninety-one percent of the patients reported excellent or good results according to Macnab outcome criteria with an average follow-up of 32.5 months (range 1-5 years). Twelve patients (28.6%) developed postoperative transient radicular pain that disappeared in 15-21 days after analgesic therapy. There were no recurrences or spinal instability. The paramedian muscle-splitting intertransverse approach is a rational technique. Its advantages are that the spine is not opened and spinal stability is maintained. It requires minimal soft-tissue and bone resection and the herniated disc is directly visualized. Moreover, it contains minimal manipulation of the neuro-vascular structures and avoids significant muscle retraction. However, it requires an adequate learning curve and good familiarity with microsurgical techniques.