Introduction Currently, the anterior cervical discectomy and fusion (ACDF) is the “gold standard” treatment after anterior cervical decompression, in elderly patients or those who have contraindications for disc prosthesis. In this context, a new anchored implant with zero profile has been introduced for ACDF, which seeks to solve the problems that entail to add an anterior cervical plate and to obtain a higher level of stability to the segment, in comparison with cage only. The objective of this study is to describe the operative and postsurgical results, associated to the new zero-profile implant COALITION (Globus Medical, Inc, Audubon, Pennsylvania, United States), in patients who had surgery after cervical spine degenerative disease. Materials and Methods The data of 32 patients were reviewed by the Spine surgeons of Hospital del Trabajador (Santiago de Chile), between 2011 and 2014 under the ACDF technique using COALITION, in the context of cervical degenerative disease. The operative time, ambulation start, hospital stay, and dysphagia and dysphonia were measured. Results The patients had an average age of 51.64 ± 9.78 DE, on a male/female ratio of 16/15. A total of 53 levels were obtained (C3–C4: 3, C4–C5: 12, C5–C6: 20, and C6–C7: 18). The operative time was an average of 167.64 ± 50.28 minutes, using autologous iliac crest graft. The ambulation start time was 1 day (range, 1–2 days), with a hospital stay of 4 days (range, 2–7 days). The immediate dysphagia in postoperative was 56.25%, from this 77.77% was mild according to Bazaz score. Only 22.2% of the patients with immediate dysphagia persisted with a mild level, according to Bazaz score after 1 week of discharge from hospital. None of the patients presented chronicle dysphagia. Only four patients presented dysphonia symptoms that remitted spontaneously. Conclusion The new zero-profile implant demonstrated good postoperative results, with a low dysphagia and dysphonia prevalence, and these were completely resolved in all the cases.
The transforaminal lumbar interbody fusion (TLIF) is used traditionally as treatment of the degenerative lumbar disease (DLD), obtaining good results. Nowadays, minimal invasive surgery (MIS) TLIF is being used as a treatment to this pathology, with the purpose of reducing damage in soft tissues, as well as, the operative time and patient recovery. The objective of this study is to measure the in-hospital and surgical parameters of a case series, which had lumbar degenerative pathology surgery using the MIS TLIF technique. Patients and MethodsData of seven patients were collected, who had surgery by the same surgeon at Hospital del Trabajador (Santiago de Chile) during 2013 under the MIS TLIF technique. The operative time, ambulation start, hospital stay, CT fusion, and complications were measured.
Introduction The Cauda Equina Syndrome (CES) is a rare clinical entity with potentially devastating consequences. Usually, patients complain concealed history of back pain and acute presentation of red flags, as severe back pain, sensory alteration in saddle or genital tract, and bladder, bowel, or sexual dysfunction. Early surgical decompression is mandatory to reduce neurological sequels. The objective of this study is to describe the clinical picture and postoperative results of patients with CES. Materials and Methods Data of 10 patients diagnosed with CES because of lumbar disc herniation (LDH) between 1994 and 2013 were collected. All of them were studied with magnetic resonance imaging or computed tomography and subsequently submitted to emergency decompressive surgery with a postoperative follow-up from 5 months to 3 years. Results The patients had an average age of 38 years (range: 19–58 years), on a male/female ratio of 8/2. Overall, 70% reported no medical history, while the remaining 30% were diabetic. Nine patients had presented a massive primary LDH and one patient was secondary to a posttraumatic LDH. All the patients had neurologic compromise ASIA D at hospital admission, but in the postoperative, 50% improved to ASIA E. The main sequel was sphincter dysfunction, present in the 50% of the patients. Conclusion Unlike what was previously reported, the majority of the patients presented immediate improvement in relation to radicular pain and motor recovery. The literature describes neurologic sequels in those patients with chronic low back pain and/or late consultation. Although our series is small, it gives us valuable information about this pathology.
Introduction Anterior cervical discectomy and fusion's (ACDF) reported pseudarthrosis rate rises up to 20% for single-level and 50% for multi-level procedures. Interspinous motion based on functional cervical spine X-rays analysis has been proposed as tool for assessing spine fusion. Previous studies comparing this assessment with direct intra operative visualization during ACDF revision surgery in patients treated with an anterior plate report that an interspinous motion of less than 1 mm correlates with complete fusion. To our knowledge, there is no literature regarding this assessment in patients undergoing an ACDF using zero profile implants. The purpose of this study is to compare interspinous motion in patients treated with an ACDF using zero profile implants to those operated with an anterior plate, after complete spinal fusion confirmation with a computed tomography (CT). Material and Methods Cross-sectional study of 22 patients with a CT-confirmed spinal fusion after ACDF. Twelve patients (16 levels) were treated with an anterior plate, while a zero profile implant was used in the remaining ten patients (17 levels). Interspinous motion at the instrumented levels was evaluated in functional cervical spine X-rays for both groups, stratified by fused level (Student's t-test, ANOVA, Stata 12). Motion values were obtained independently by a radiologist and an orthopedic surgeon, following Song's guidelines (Song et al. J Bone Joint Surg Am 2014;96:557–63). Results Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level (p = 0.0082). The instrumented level did not affect interspinous motion (p > 0.05). Conclusion Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level (p = 0.0082). The instrumented level did not affect interspinous motion (p > 0.05).
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