RESUMEN

OBJECTIVE: To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. METHOD: A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. RESULTS: Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. CONCLUSIONS: The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

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OBJETIVO: Evaluar los resultados clínico-quirúrgicos del abordaje tipo tubular en comparación con el mini-open en la discoidectomía lumbar. El abordaje tubular promete reducir el número de días de reposo y una reincorporación más temprana a las actividades diarias y laborales. MÉTODO: Se realizó un estudio de casos y controles de pacientes operados por hernia discal mediante cirugía tubular (casos) o mini-open (controles). Las variables investigadas fueron: dolor radicular y lumbar, sexo, edad, falla en el tratamiento conservador, hernia lumbar de un solo nivel, tiempo quirúrgico, sangrado, tiempo de estancia hospitalaria, persistencia de síntomas, complicaciones, tipo de actividad ocupacional y reinserción a las actividades cotidianas. RESULTADOS: Se realizaron 100 cirugías y se crearon dos grupos, tubular y mini-open, con 50 pacientes cada uno, con hernia discal de L4-L5 o L5-S1, respectivamente. El nivel más afectado fue L4-L5 (69%). Del total de los casos, se encontró mejoría significativa (p < 0.05) a los 15 días posquirúrgicos en la escala EVA y ODI en el grupo tubular con respecto al mini-open. Ocurrieron complicaciones como infección de herida quirúrgica, durotomía y dolor persistente. CONCLUSIONES: El abordaje tubular es una opción segura y efectiva para hernias discales del segmento lumbar, y reduce los tiempos quirúrgicos, el sangrado y el tiempo de reinserción a las actividades cotidianas del paciente.

Asunto(s)

Discectomía , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Masculino , Femenino , Estudios de Casos y Controles , Vértebras Lumbares/cirugía , Adulto , Desplazamiento del Disco Intervertebral/cirugía , Persona de Mediana Edad , Discectomía/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Tempo Operativo , Tiempo de Internación/estadística & datos numéricos

RESUMEN

BACKGROUND: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS: We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS: The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS: FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.

Asunto(s)

Degeneración del Disco Intervertebral , Vértebras Lumbares , Humanos , Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Endoscopía/métodos , Neuroendoscopía/métodos , Discectomía/métodos

RESUMEN

Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ​​por dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.

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Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.

Asunto(s)

Humanos , Dolor Facial/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Artroscopía/métodos , Articulación Temporomandibular/cirugía , Discectomía/métodos , Artrocentesis/métodos

RESUMEN

INTRODUCTION: Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS: Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS: We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION: Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.

Asunto(s)

Discectomía Percutánea , Desplazamiento del Disco Intervertebral , Enfermedades de la Médula Espinal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Discectomía/efectos adversos , Discectomía/métodos , Discectomía Percutánea/efectos adversos , Discectomía Percutánea/métodos , Endoscopía/efectos adversos , Endoscopía/métodos , Hematoma/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Parestesia , Estudios Retrospectivos , Enfermedades de la Médula Espinal/cirugía , Resultado del Tratamiento

RESUMEN

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. MATERIALS AND METHODS: Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. RESULTS: We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. CONCLUSIONS: Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.

Asunto(s)

Enfermedades de la Médula Espinal , Fusión Vertebral , Humanos , Resultado del Tratamiento , Estudios Retrospectivos , Calidad de Vida , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Discectomía/métodos , Fusión Vertebral/métodos , Enfermedades de la Médula Espinal/cirugía , Medición de Resultados Informados por el Paciente

RESUMEN

The present objective was to increase the number of biomechanical cycles performed using non-chondrodystrophic dog specimens, based on the study by Araújo (2017), comparing partial lateral corpectomy (PLC) alone, corpectomy and pediculectomy, and PLC associated with pediculectomy and hemilaminectomy to determine if there are significant differences between them regarding deformation versus applied force. Groups were divided as: control (G1), corpectomy (G2), corpectomy +pediculectomy (G3), and corpectomy + pediculectomy + hemilaminectomy (G4). The level of displacement versus force was observed during axial compression, flexion, extension, right and left lateral bending, and right and left axial rotation. Significant differences were observed between groups for flexion, extension, right and left axial rotation, and left lateral bending, whereas there was no difference for axial compression and right lateral bending. PLC and PLC with pediculectomy had significant differences in flexion and in extension, similar to PLC associated with pediculectomy and with hemilaminectomy in right and left axial rotation, flexion, extension, and right lateral bending.

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O presente objetivo foi, a partir de grupos de espécimes caninas não condrodistróficas, aumentar o número de ciclos biomecânicos realizados, com base no estudo de Araújo (2017), comparando-se corpectomia parcial lateral (CPL) isolada, corpectomia e pediculectomia, à CPL associada à pediculectomia e à hemilaminectomia, no intuito de determinar se há diferenças significativas entre eles quanto à deformação versus à força aplicada. Os grupos foram divididos em: controle (G1), corpectomia (G2), corpectomia + pediculectomia (G3) e corpectomia + pediculectomia + hemilaminectomia (G4). O nível de deslocamento versus a força foi observado durante a compressão axial, a flexão, a extensão, a flexão lateral direita e esquerda e a rotação axial direita e esquerda. Observaram-se diferenças significativas entre os grupos para flexão, extensão, rotação axial direita e esquerda e flexão lateral esquerda, ao passo que, na compressão axial e na flexão lateral direita, não houve diferença. CPL e CPL com pediculectomia tiveram diferenças significativas na flexão e na extensão, semelhantemente à CPL associada à pediculectomia e à hemilaminectomia nos movimentos de rotação axial direita e esquerda, flexão, extensão e flexão lateral direita.

Asunto(s)

Animales , Perros , Compresión de la Médula Espinal/cirugía , Discectomía/métodos , Discectomía/veterinaria , Degeneración del Disco Intervertebral/veterinaria

RESUMEN

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. SUMMARY OF BACKGROUND DATA: A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown. METHODS: All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period. RESULTS: Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (ß=-4.62, P =0.096), Neck Disability Index (ß=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (ß=-1.16, P =0.694), VAS Arm (ß=0.06, P =0.944), or VAS Neck (ß=-0.44, P =0.617). CONCLUSION: Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs. LEVEL OF EVIDENCE: Levwl III.

Asunto(s)

Uso de la Marihuana , Fusión Vertebral , Humanos , Adolescente , Adulto , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Discectomía/efectos adversos , Discectomía/métodos , Vértebras Cervicales/cirugía , Analgésicos Opioides , Resultado del Tratamiento

RESUMEN

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Asunto(s)

Humanos , Masculino , Anciano , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/complicaciones , Ligamento Amarillo/fisiopatología , Compresión de la Médula Espinal/diagnóstico por imagen , Fusión Vertebral/métodos , Vértebras Cervicales , Resultado del Tratamiento , Discectomía/métodos , Espondilosis , Laminectomía/métodos

RESUMEN

STUDY DESIGN: Prospective cohort. OBJECTIVE: The aim of this study was to determine the effect of graft type on residual motion and the relationship among residual motion, smoking, and patient-reported outcome (PRO) scores following anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Although most patients develop solid fusion based on static imaging following ACDF, dynamic imaging has revealed that many patients continue to have residual motion at the arthrodesis. METHODS: Forty-eight participants performed dynamic neck flexion/extension and axial rotation within a biplane radiography system 1 year following ACDF (21 one-level, 27 two-level). PRO scores included the Short Form-36, Neck Disability Index, and Cervical Spine Outcomes Questionnaire. An automated model-based tracking process matched subject-specific bone models to the biplane radiographs with sub-millimeter accuracy. Residual motion was measured across the entire arthrodesis site for both one- and two-level fusions in patients who received either allograft or autograft. Patients were divided into "pseudarthrosis" (>3° of flexion/extension residual motion) and "solid fusion" groups. Residual motion and PROs were compared between groups using Student t tests. RESULTS: Patients who received allograft showed more total flexion/extension residual motion (4.1° vs. 2.8°, P = 0.12), although this failed to reach significance. No differences were noted in PROs based on graft type (all P > 0.08) or the presence of pseudarthrosis (all P > 0.13). No differences were noted in residual motion between smokers and nonsmokers (all P > 0.15); however, smokers who received allograft reported worse outcomes than nonsmokers who received allograft and smokers who received autograft. CONCLUSION: Allograft may result in slightly more residual motion at the arthrodesis site 1 year after ACDF. However, there is minimal evidence that PROs are adversely affected by slightly increased residual motion, suggesting that the current definition of pseudarthrosis correlates poorly with clinically significant findings. Additionally, autograft appears to result in superior outcomes in patients who smoke.Level of Evidence: 2.

Asunto(s)

Vértebras Cervicales/cirugía , Discectomía , Medición de Resultados Informados por el Paciente , Fusión Vertebral , Discectomía/efectos adversos , Discectomía/instrumentación , Discectomía/métodos , Humanos , Estudios Prospectivos , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Trasplantes/trasplante

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Discectomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Creatina Quinasa/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Periodo Posoperatorio , Ciática/diagnóstico por imagen , Estudios Prospectivos , Resultado del Tratamiento , Vértebras Lumbares/cirugía

RESUMEN

BACKGROUND: Cervical spine degenerative disease is one of the main causes of myelopathy. Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure used to treat cervical myelopathy. Therefore, it is important to study pseudarthrosis rates after ACDF and correlate them with the graft used. METHODS: We performed a systematic review to evaluate the relationship between pseudarthrosis after ACDF and the interbody graft used. RESULTS: A total of 3732 patients were evaluated in 46 studies. The mean age of the included patients was 51.5 ± 4.18 years (range, 42-59.6 years). ACDF is most often perforemd as single-level surgery and the level most impaired is C5-C6. The use of titanium cages, zero profile, recombinant human bone morphogenetic protein 2, and carbon cages was seen as a protective factor for pseudarthrosis compared with the autograft group (control group); with an odds ratio of 0.29, 0.51, 0.03, and 0.3, respectively; the results were statistically relevant. The use of polyetheretherketone, poly(methyl methacrylate), and trabecular metal was a risk factor for development of pseudarthrosis compared with the control group, with an odds ratio of 1.7, 8.7, and 6.8, respectively; the results were statistically relevant. Radiologic follow-up was an important factor for the pseudarthrosis rate; paradoxically, a short follow-up (<1 year) had lower rates of pseudarthrosis and follow-up >2 years increased the chance of finding pseudarthrosis. CONCLUSIONS: Different types of grafts lead to a significant difference in pseudarthrosis rates. Follow-up time is also an important factor that affects the rate of pseudarthrosis after ACDF.

Asunto(s)

Trasplante Óseo/métodos , Vértebras Cervicales/cirugía , Discectomía/métodos , Complicaciones Posoperatorias/epidemiología , Implantación de Prótesis/métodos , Seudoartrosis/epidemiología , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Benzofenonas , Proteína Morfogenética Ósea 2/uso terapéutico , Carbono , Humanos , Cetonas , Oportunidad Relativa , Polietilenglicoles , Polímeros , Polimetil Metacrilato , Diseño de Prótesis , Proteínas Recombinantes/uso terapéutico , Factores de Riesgo , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Columna Vertebral/complicaciones , Titanio , Factor de Crecimiento Transformador beta/uso terapéutico , Trasplante Autólogo

RESUMEN

BACKGROUND: The benefits of minimally invasive spine surgery are attainable only if hospitals have the financial resources to acquire essential equipment. We present a surgical approach readily available to countries where unacceptably expensive materials are the main limitation for use of minimally invasive spine surgery. METHODS: This retrospective study included 30 patients who underwent minimally invasive spine surgery using syringes as dilators and retractors for posterior lumbar approaches. Inclusion criteria were lumbar radicular/back pain, degenerative disc, spondylolysis, unilateral approach, and maximum of 2 affected spine levels. Demographic characteristics, affected radicular level, diagnosis, type and length of surgery, hospital length of stay, MacNab criteria, complications, and resumption of daily activities were analyzed. RESULTS: Of 30 patients, 17 (56.6%) presented with S1 radicular pain. Pain was mainly due to posterolateral hernia (70%; n = 21) requiring 1-level discectomy. In 6 patients (20%), discectomy and an interspinous process device were required. One patient (3.33%) underwent 2-level discectomy. All surgeries were performed using syringes as dilators and retractors. Maximum syringe diameter used was 2 cm (20-mL syringes) in 29 patients (96.6%) and 3 cm (60-mL syringe) in 1 patient. Average length of surgery was 1.5 hours, and average hospital stay was 1.8 days. Based on MacNab criteria, excellent, good, and fair outcomes were achieved in 25 patients (83%), 3 patients (10%), and 2 patients (6.7%). Complications were observed in 5 patients (16.7%). CONCLUSIONS: This is a safe and feasible technique with excellent results obtained at low cost and is becoming an attractive surgical option in developing countries.

Asunto(s)

Discectomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adulto , Anciano , Países en Desarrollo , Discectomía/instrumentación , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Estudios Retrospectivos , Jeringas , Adulto Joven

RESUMEN

Abstract Prone position though is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

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Resumo O posicionamento em decúbito ventral, embora comumente usado para melhorar o acesso ao local cirúrgico, pode estar associado a uma variedade de complicações. Distúrbios ou perda visual no Perioperatório é uma complicação rara, mas devastadora, que está principalmente associada à cirurgia de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA - II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

Asunto(s)

Humanos , Femenino , Adulto , Anisocoria/etiología , Midriasis/etiología , Posición Prona , Discectomía/métodos , Complicaciones Posoperatorias/diagnóstico , Estudios de Seguimiento , Discectomía/efectos adversos , Vértebras Lumbares/cirugía

RESUMEN

Prone position is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible because of anisocoria. Anisocoria partially improved but persisted till follow up.

Asunto(s)

Anisocoria/etiología , Discectomía/métodos , Midriasis/etiología , Posición Prona , Adulto , Discectomía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/diagnóstico

RESUMEN

INTRODUCTION: Cervical disc arthroplasty (CDA) was developed to decrease the rate of symptomatic adjacent-level disease while preserving motion in the cervical spine. METHODS: The objectives of this paper are to provide criteria for proper patient selection as well as to present a comprehensive literature review of the current evidence for CDA, including randomized studies, the most recent meta-analysis findings, and long-term follow-up clinical trials as well. RESULTS: Currently, there are several prospective randomized controlled studies of level I of evidence attesting to the safety and efficacy of CDA in the management of cervical spondylotic disease (CSD) for one- or two-level degenerative diseases. These as well as recent meta-analyses suggest that CDA is potentially similar or even superior to anterior cervical discectomy and fusion (ACDF) when considering several outcomes, including dysphagia and re-operation rate over medium-term follow-up. Less robust studies have also reported satisfactory clinical and radiological outcomes of CDA for hybrid procedures (ACDF combined with CDA), non-contiguous disease, and even for multilevel disease (more than 2 levels). CONCLUSIONS: Based on this evidence we conclude that CDA is a safe and effective alternative to ACDF in properly selected patients for one- or two-level diseases. Defining superiority of specific implants and detailing optimal surgical indications will require further well-designed long-term studies.

Asunto(s)

Artroplastia , Discectomía , Degeneración del Disco Intervertebral , Fusión Vertebral , Artroplastia/métodos , Vértebras Cervicales/cirugía , Discectomía/métodos , Humanos , Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/cirugía , Selección de Paciente , Estudios Prospectivos , Reoperación , Fusión Vertebral/métodos , Espondilosis/cirugía , Resultado del Tratamiento

RESUMEN

Introducción: las cajas cervicales son implantes desarrollados como una alternativa a la utilización del injerto óseo estructural para la fusión cervical anterior. El objetivo de este estudio fue analizar la clínica y los resultados radiológicos en una serie de pacientes sometidos a disectomía y descompresión cervical anterior, a los que se les implantó una caja PEEK. Método: estudio retrospectivo, descriptivo, longitudinal de una serie de 78 pacientes incluidos en el estudio desde el año 2007 al 2013. El control radiológico incluyó radiografía anteroposterior y lateral. El seguimiento clínico y radiológico de los pacientes se llevó a cabo desde los 3 meses hasta los 12 meses. Resultados: 65 pacientes tuvieron una evolución clínica favorable (83,3 por ciento) y la evolución radiológica confirmó que 66 pacientes (84,6 por ciento) tenían una buena colocación del injerto, sin lesiones en espacios adyacentes con una fusión correcta. Conclusiones: hasta la fecha hay pocos estudios descriptivos sobre el implante de las cajas PEEK, los resultados mostrados en este trabajo están acordes a los publicados con anterioridad en este mismo campo, lo que da validez al trabajo presentado. Este estudio confirma los buenos resultados clínicos y radiológicos de pacientes a los que se les implantó una caja PEEK; se muestra su eficacia en la discectomía cervical anterior y artrodesis(AU)

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Introduction: Cervical cases are implants developed as an alternative to the use of structural bone graft for anterior cervical fusion. The objective of this study was to analyze the clinical and radiological results in a series of patients submitted to anterior cervical dissectomy and decompression, to whom a PEEK box was implanted. Method: A retrospective, descriptive, longitudinal study was conducted in a series of 78 patients included in the study from 2007 to 2013. Radiological control included anteroposterior and lateral radiographies. Clinical and radiological follow-up of these patients was carried out from 3 months to 12 months. Results: 65 patients had a favorable clinical course (83.3 percent) and the radiological evolution confirmed that 66 patients (84.6 percent) had a good placement of the graft without lesions in adjacent spaces with a correct fusion. Conclusions: To date there are few descriptive studies on the implantation of PEEK boxes. This paper results are in line with those published previously in this same field, which legitimate the presented work. This study confirms the good clinical and radiological results in patients who were implanted with a PEEK box; its effectiveness in anterior cervical discectomy and arthrodesis is shown(AU)

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Introduction: Les cages cervicales sont des implants développés comme alternative de la greffe osseuse structurelle pour la fusion cervicale antérieure. Le but de cette étude est d'analyser la technique et les résultats radiologiques dans une série de patients traités par discectomie et décompression cervicale antérieure, et implantation d'une cage PEEK. Méthodes: Étude rétrospective, descriptive et longitudinale d'une série de 78 patients inclus dans une étude depuis l'année 2007 jusqu'à l'année 2013. L'étude radiologique a compris des clichés en position antéro-postérieure et latérale. Le suivi clinique et radiologique des patients a pris de 3 à 12 mois. Résultats: L'évolution clinique a été satisfaisante chez 65 patients (83,3 pourcent), tandis que l'étude radiologique a confirmé que le greffon était bien placé, il n'y avait pas de lésions dans les espaces adjacentes, et la fusion était correcte chez 66 patients (84,6 pourcent). Conclusions: Jusqu'à maintenant, il y a peu d'études descriptives abordant l'implantation des cages PEEK. Le présent travail est validé, car ses résultats sont en concordance avec les travaux publiés auparavant dans ce domaine. Cette étude confirme les bons résultats obtenus chez les patients ayant subi l'implantation d'une cage PEEK ; son efficacité est démontrée dans la discectomie cervicale antérieure et l'arthrodèse(AU)

Asunto(s)

Humanos , Adulto , Persona de Mediana Edad , Anciano , Artrodesis/métodos , Discectomía/métodos , Autoevaluación Diagnóstica , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios Longitudinales , Resultado del Tratamiento , Cuidados Posteriores

RESUMEN

STUDY DESIGN: To evaluate the biomechanical stability of 2 extender plates in a human cervical cadaveric model. OBJECTIVES: To evaluate 2 extender plates, placed adjacent to initially implanted plates and to compare their biomechanical stability with traditional techniques. SUMMARY OF BACKGROUND DATA: Traditionally, adjacent level degeneration is surgically treated by removing the previously implanted plate and extending the instrumentation to the new degenerated level. The exposure needed to remove the previously implanted plate may be extensive. To overcome these complications, cervical extension plates, which add-on to the initially implanted plate, were developed. MATERIALS AND METHODS: Fourteen fresh-frozen human cadaver cervical spines (C2-C7) were divided into 2 groups of 7 for a series of constructs to be tested. In group 1, an extender plate, which attaches to its own primary plate, was tested. In group 2, a universal extender plate, which can be placed adjacent to any previously implanted plate, was tested. The specimens prepared were mounted on a 6-degree-of-freedom spine simulator and were sequentially tested in the following order: (1) intact; (2) single-level plate; (3) single-level plate with extender plates; and (4) 2-level plate. An unconstrained pure moment of ±1.5 N m was used in flexion-extension, lateral bending, and axial rotation. RESULTS: All instrumented constructs significantly reduced the range of motion compared with the intact condition. In both the groups, single-level plates with adjacent extender plates demonstrated stability comparable to their respective 2-level plates in all loading modes. CONCLUSIONS: Extender plates give surgeons the opportunity to treat adjacent levels without removing the primary implants, which may reduce the overall risk of damage to vital neurovascular structures. From this cadaveric biomechanical model, both types of extender plates prove to be viable options for treating adjacent level degeneration.

Asunto(s)

Placas Óseas , Vértebras Cervicales/cirugía , Discectomía/métodos , Degeneración del Disco Intervertebral/terapia , Fusión Vertebral/métodos , Adulto , Anciano , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología

RESUMEN

STUDY DESIGN: A systematic review. OBJECTIVE: To determine the effect of plate design on fusion rates in patients undergoing a 1- and 2-level anterior cervical discectomy and fusion (ACDF). METHODS: Articles published between January 1, 2002 and January 1, 2015 were systematically reviewed to determine the fusion rate of 1- and 2-level ACDFs using either a fully constrained or semiconstrained locking plate. Additional variables that were collected included the number of levels, the type of graft/cage used, the study design, the method for determining fusion, and complications. RESULTS: Fifty-two articles and 3053 patients were included. No significant difference in the fusion rate for 1- and 2-level ACDF using a fully constrained plate (96.1%) and a semiconstrained plate (95.29%) was identified (P=0.84). No difference (P=0.85) in the total complication rate between fully constrained plates (3.20%) and semiconstrained plates (3.66%), or the rate of complications that required a revision (2.17% vs. 2.41%, P=0.82) was identified. However, semiconstrained plates had a nonsignificant increase in total dysphagia rates (odds ratio=1.660, P=0.28) and short-term dysphagia rates (odds ratio=2.349, P=0.10). CONCLUSIONS: In patients undergoing a 1- or 2-level ACDF, there is no significant difference in the fusion or complication rate between fully constrained plates and semiconstrained plates. LEVEL OF EVIDENCE: Level II-systematic review.

Asunto(s)

Vértebras Cervicales/cirugía , Discectomía/métodos , Complicaciones Posoperatorias/etiología , Prótesis e Implantes , Radiculopatía/cirugía , Fusión Vertebral/métodos , Bases de Datos Bibliográficas , Humanos , Enfermedades de la Médula Espinal/cirugía

RESUMEN

STUDY DESIGN: A retrospective cohort study of prospectively collected data. OBJECTIVE: As an initial effort to address readmissions after lumbar discectomy, reasons for hospital readmission are identified and discussed. SUMMARY OF BACKGROUND DATA: Lumbar discectomy is a commonly performed procedure. The Affordable Care Act codifies penalties for hospital readmissions. New quality-based reimbursements tied to readmissions call for a better understanding of the causes of readmission after procedures such as lumbar discectomy. METHODS: Lumbar discectomies performed in 2012 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, surgical variables, and reasons for readmissions within 30 days were recorded. Pearson chi square was used to compare rates of demographics and surgical variables between readmitted and nonreadmitted patients. Multivariate regression was used to identify risk factors for readmission. RESULTS: Of 20,376 lumbar discectomies, 533 patients (2.62%) were readmitted within 30 days of surgery. The most common reasons for readmission were surgical site infections (n = 130, 0.64% of all discectomies, 24.4% of all readmissions), followed by pain issues (n = 89, 0.44%, 16.7%), and thromboembolic events (43, 0.21%, 8.1%). Overall time to readmission was 13.0 ±â€Š8.0 days (mean ±â€Šstandard deviation). Factors most associated with readmission after lumbar discectomy were higher American Society of Anesthesiologists class (relative risk = 1.49, P < 0.001) and prolonged operative time (relative risk = 1.41, P = 0.002). CONCLUSION: Surgical site infection, postoperative pain, and thromboembolic events were the most common reasons for readmission after lumbar discectomy. These findings identify potential areas for quality improvement initiatives. LEVEL OF EVIDENCE: 3.

Asunto(s)

Discectomía/efectos adversos , Dolor/etiología , Readmisión del Paciente , Infección de la Herida Quirúrgica/etiología , Tromboembolia/etiología , Adolescente , Adulto , Anciano , Discectomía/métodos , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven

RESUMEN

The purpose of this case-control study is to compare the treatment algorithm and complication rate for patients who undergo an anterior cervical discectomy and fusion at a physician-owned specialty hospital to those who undergo surgery at a university-owned tertiary care hospital. Two controls were identified for 77 patients, and no differences in demographic data were identified. The median time between the onset of symptoms and surgery was shorter for patients who had surgery at the tertiary care center than for patients who had surgery at the specialty hospital (26.7 weeks vs 32.7 weeks, P = .0004). Furthermore, a higher percentage of patients who had surgery at the specialty hospital attempted nonoperative treatments than patients who underwent surgery at the tertiary care hospital.

Asunto(s)

Vértebras Cervicales/cirugía , Discectomía , Hospitales Especializados , Propiedad , Fusión Vertebral , Centros de Atención Terciaria , Algoritmos , Estudios de Casos y Controles , Discectomía/efectos adversos , Discectomía/métodos , Discectomía/estadística & datos numéricos , Femenino , Hospitales Especializados/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Propiedad/normas , Propiedad/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/estadística & datos numéricos , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Factores de Tiempo