Background Data: Recurrent lumbar disc herniation is reported from 5 to 11%. Optimal surgical approach for recurrent disc prolapse is controversial. Some authors believe that repeat discectomy is the treatment of choice, with similar clinical results compared to the primary procedure. Some spine surgeons believe that fusion is necessary for treating disc reherniation. Purpose: Our aim is to compare the clinical outcome in patients with recurrent lumbar disc herniation operated by conventional rediscetomy versus those operated by TLIF with unilateral pedicle screw fixation. Study Design: A descriptive controlled, non-randomized, retrospective, clinical study. Patients and Methods: Forty patients underwent surgery for recurrent lumbar disc herniation. They were divided into two groups; re-discectomy group and TLIF with unilateral fixation group. Each group included 20 patients. They were operated between 2008 and 2016. Participants were evaluated pre-operatively and post-operatively every three months. Operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. In addition fusion was looked for radiologically. better clinical outcome parameters including better VAS for low back pain and better Prolo economic, functional rating scale. In comparison the re-discectomy group showed significantly higher complications and reoperation during the follow up period. Conclusion: Patients with recurrent lumbar disc herniation operated by TLIF with unilateral spinal fixation reported less pain & lower disability scores all over the follow up period. This technique is preferable to conventional re-discectomy because it avoids the possibility of recurrence and has less postoperative complications. (2016ESJ124)
Background Data: Late Post-traumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment. There are several surgical options to correct late post-traumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of clinical and radiological outcome success. Purpose: The aim of this study was to assess the use of a pedicle disc wedge osteotomy for the treatment of late post-traumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated by this technique. Study Design: A descriptive retrospective clinical case study. Patients and Methods: Ten consecutive patients with symptomatic post-traumatic thoracolumbar kyphosis were treated using a pedicle disc wedge osteotomy. The mean patient age was 37.5 years. The initial trauma in all patients was Type A3, A4 according to AOSPINE thoracolumbar trauma classification. The kyphosis apex ranged from T-12 to L-2. The sagittal alignment, kyphotic angle, neurological function, Visual Analog Scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. Results: The mean preoperative regional angle was 35.5°, and the mean correction angle was 28.5°. Sagittal alignment improved with a mean correction rate of 47%. The mean surgical time was 227 minutes, and the mean intraoperative blood loss was 1380 ml. The mean Visual Analog Score for back pain improved from 8.2 to 2.0, and the Oswestry Disability Index score decreased from 56.4 to 24.4 at the last follow-up. All patients achieved bony fusion based on the presence of trabecular bone bridging at the osteotomy site. Conclusion:The pedicle disc wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion. (2017ESJ139)
Background Data: Metastatic spine disease continues to be an increasing burden. The cervicothoracic junction represents a transition from the semi rigid thoracic spine to the mobile sub axial cervical spine. Pathologic lesions are prone to result in kyphotic deformity as well as to the possibility of neurological deficits.
Background Data: Optimal surgical approach for anterior cervical discectomy and fusion (ACDF) is still controversial. Some authors believe that addition of locking plate (ACDFP) has higher costs and longer operative time. Other surgeons believe that ACDFP have better clinical outcomes and more sound fusion. The debate is higher in single and double level ACDF. Purpose: To compare the clinical and radiological outcomes in patients with single or double level cervical disc herniation operated by ACDF versus those operated by ACDFP. Study Design: A retrospective, descriptive controlled, non-randomized, clinical case study. Patients and Methods: Forty patients underwent ACDF. They were divided into two groups; ACDF group and ACDFP fixation group. Each group included 20 patients. They were operated between 2010 and 2017. Participants were evaluated pre-operatively and post-operatively 1, 3, 6, 9 and 12 months after surgery. Operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both upper arm and cervical pain. The clinical outcomes were compared using Odom's criteria. Cervical fusion was assessed radiologically. Results: The demographic data of the two groups of patients were fairly homogeneous and comparable. ACDFP group showed slightly better clinical outcome parameters in comparison to ACDF group including VAS for cervical pain (9±5 versus 28±11) and Odom's criteria scores (15 excellent outcome versus 10). Also ACDFP group showed slightly better radiological fusion rate (100%) in comparison to (85%) in ACDF group. Reported nonunion was higher in ACDF group (15%) in comparison to ACDFP group (0%). Conclusion: Our data suggest that the addition of cervical plate fixation to ACDF might leads to better clinical outcome and radiological fusion in single and double cervical disc disease. (2018ESJ155)
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