RESUMEN
OBJECTIVE: Posterior lumbar interbody fusion is a recognized procedure for the treatment of back pain associated with degenerative disc disease and segmental instability. It allows decompression of the spinal canal and circumferential fusion through a single posterior incision. METHODS: Sixty-five consecutive patients who underwent posterior lumbar interbody fusion using carbon cages and pedicle fixation between 1993 and 2000 were recruited and contacted with a postal survey. Clinical outcome was assessed by the postoperative clinical findings and complications and the fusion rate, which was assessed using the scoring system described by Brantigan and Steffee. Functional outcome was measured by using improvement in the Oswestry Disability Index, return to work, and satisfaction with the surgical outcome. The determinants of functional relief were analyzed against the improvement in disability using multiple regression analysis. RESULTS: The mean postoperative duration at the time of the study was 4.4 years. Overall radiologic fusion rate was 98%. There was a significant improvement in Oswestry Disability Index (P < 0.01). There was 84% satisfaction with the surgical procedure and 61% return to predisease activity level and full employment. We found preoperative level of disability to be the best determinant of functional recovery irrespective of age or the degree of psychological morbidity and litigation (P < 0.01). CONCLUSION: The combination of posterior lumbar interbody fusion and posterior instrumented fusion is a safe and effective method of achieving circumferential segmental fusion. A direct relationship between preoperative level of disability and functional recovery suggests that disability should be measured preoperatively and spinal fusion should be performed to alleviate disability caused by degenerative spine.
Asunto(s)
Dolor de Espalda/epidemiología , Dolor de Espalda/prevención & control , Evaluación de la Discapacidad , Desplazamiento del Disco Intervertebral/epidemiología , Desplazamiento del Disco Intervertebral/cirugía , Fusión Vertebral/instrumentación , Fusión Vertebral/estadística & datos numéricos , Adulto , Anciano , Placas Óseas/estadística & datos numéricos , Carbono , Fibra de Carbono , Comorbilidad , Empleo/estadística & datos numéricos , Femenino , Humanos , Irlanda/epidemiología , Estudios Longitudinales , Vértebras Lumbares/cirugía , Masculino , Dimensión del Dolor , Satisfacción del Paciente/estadística & datos numéricos , Pronóstico , Recuperación de la Función , Resultado del TratamientoRESUMEN
We conducted a retrospective, clinical and radiological study of fixation with a single screw in slipped upper femoral epiphysis. Forty children (53 hips) who had a slipped upper femoral epiphysis were managed by in-situ pinning with a single cannulated screw. The average age of these patients was 12.7 years and their average weight was above the 50th centile at the time of diagnosis. There were three acute slips, eight acute-on-chronic slips and 35 chronic slips. They were followed for an average of 2 years. Fifty-eight percent of patients had an excellent clinical result, 36% a good result, 4% a fair result and 2% a poor result. The complication rate was 5.3%. Our experience with single cannulated screw fixation of slipped upper femoral epiphysis is encouraging. No complications resulted from the choice of the fixation device.