Introduction Degenerative lumbar spinal stenosis is present in patients around 50 to 60 years old. It is the most common spinal surgical indication in patients over 65 years old. The aim of this study was to determine the risk factors associated with adverse events and reintervention after surgery for degenerative lumbar spinal stenosis, based on a 10-year retrospective analysis of clinical records in a third level hospital in Bogotá, Colombia. Material and Methods An analytical prevalence study was developed through 429 clinical records of patients who underwent surgery for degenerative lumbar spinal stenosis. Results 429 clinical records were reviewed. 55% were female; the mean age was 55 years +/−16,5. The average follow up was 33,8 months. Adverse events were present in 17,2% of patients. Dural lesion was the most frequent complication (9.8%). Multivariate analysis showed a relation between complications and BMI (OR 1,8; p = 0,029), duration of symptoms (OR 1,08; p = 0,047), length of stay (OR 1,67; p = 0,023) and multi level surgery (OR: 2.99; p = 0,015). 4.7% of patients required early reintervention after surgery and 16,1% required it during follow-up. The most common late reintervention cause was re-stenosis of the same segment (7%). Adjacent segment disease was present in 6,1% of patients. Conclusion BMI, duration of symptoms, length of stay and multi level surgery were identified as risk factors for adverse events and reintervention after surgery for degenerative lumbar spinal stenosis. Mitigation of these risk factors before surgery for degenerative lumbar spinal stenosis, may decrease the proportion of complications and reinterventions in our institutions.
Introduction Many etiologies can lead to atlantoaxial subluxation. In Grisel syndrome, this subluxation occurs spontaneously after inflammatory processes of the head and neck. Nonsurgical treatment most often resolves the symptoms; however, in some cases, surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population. We aim to describe a modified surgical technique for the treatment of atlantoaxial subluxation in a child with Grisel syndrome. Patient and Methods: Our case study involves a 5-year-old female patient with a 6-month history of unresolved Fielding type II atlantoaxial subluxation because of the Grisel syndrome. Despite conservative treatment, the patient's symptoms continued to progress. After two failed closed reduction attempts, open reduction and C1–C2 fusion with a modified Goel–Harms technique was performed with atlas laminar hook and axis pedicle polyaxial screws. A literature review of the surgical treatment of the Grisel syndrome was also performed. Results After surgery, the patient exhibited full clinical and functional recoveries with complete resolution of symptoms. At the 24-month follow-up examination, there was continual evidence of satisfactory reduction and fusion. No complications were observed. On completion of the literature review, seven Grisel syndrome cases were found to have been treated surgically with the minimum patient age being 9 years. Conclusion Conservative management of Grisel syndrome is the most common and effective treatment; however, a few surgical cases have been reported in the literature with good results. We exhibit a safe, new surgical construct for pediatric patients in the treatment of atlantoaxial subluxation and instability, with satisfactory clinical results and solid fusion at 24 months postsurgery.
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