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Acute onset back pain is a common reason for referral to primary health care or emergency departments. In this review, the different spine fracture types are highlighted, and a treatment algorithm is proposed. CT is the modality of choice when a spine fracture is suspected. MRI should be performed when disc or ligamentous lesions are suspected or in patients with known ankylosis or diffuse idiopathic skeletal hyperostosis. Treatment is mainly conservative with bracing, but unstable fractures and patients with neurological deficits should be treated surgically.

Study design: Retrospective study. Objective: To report the incidence of revision surgery due to mechanical failure following pedicle subtraction osteotomy (PSO) in adult spinal deformity (ASD) patients. Summary of background data: PSO allow major surgical correction of ASD, although; the risk of mechanical complications remains considerable. Previous reports have been based on smaller cohorts or multicenter databases and none have utilized competing risk (CR) survival analysis. Methods: All ASD patients undergoing PSO surgery from 2010 to 2015 at a single, tertiary institution were included. Demographics, long standing radiographs as well as intra- and postoperative complications were registered for all. A CR-model was used to estimate the incidence of revision surgery due to mechanical failure and two predefined multivariable models were used to assess radiographic prediction of failure and reported as odds ratios (OR) with 95% confidence intervals (95% CI). Results: A total of 171 patients were included with 2-year follow-up available for 91% (mean [IQR]: 35 [24–50] months). Mechanical failure occurred in 111 cases (65%) at any time in follow-up, the most frequent being rod breakage affecting 81 patients (47%). Cumulative incidence of revision surgery due to mechanical failure was estimated to 34% at 2 years and 58% at 5 years. A multivariable proportional odds model with death as competing risk showed significantly increased odds of revision with fusion to the sacrum (OR: 5.42; 95% CI 1.89–15.49) and preoperative pelvic tilt (PT) > 20° (OR: 2.41; 95% CI 1.13–5.16). History of previous surgery, number of instrumented vertebra, as well as postoperative SRS-Schwab modifiers and Global Alignment and Proportion score were not associated with significant effects on odds of revision. Conclusions: In a consecutive single-center cohort of patients undergoing PSO for ASD, we found an estimated incidence of revision surgery due to mechanical failure of 34% 2 years po

Study design: This is a single-center, retrospective study. Objective: To assess if implemented changes to clinical practice have reduced mechanical complications following pedicle subtraction osteotomy (PSO) surgery. Summary of background data: Adult spinal deformity (ASD) is increasing in prevalence with concurrent increasing demands for surgical treatment. The most extensive technique, PSO, allows for major correction of rigid deformities. However, surgery-related complications have been reported in rates up to 77% and especially mechanical complications occur at unsatisfactory frequencies. Methods: We retrospectively included all patients undergoing PSO for ASD between 2010 and 2016. Changes to clinical practice were introduced continuously in the study period, including rigorous patient selection; inter-disciplinary conferences; implant-material; number of surgeons; surgeon experience; and perioperative standardized protocols for pain, neuromonitoring and blood-loss management. Postoperative complications were recorded in the 2-year follow-up period. Competing risk survival analysis was used to assess cumulative incidence of revision surgery due to mechanical complications. The Mann–Kendall test was used for analysis of trends. Results: We included 185 patients undergoing PSO. The level of PSO changed over the study period (P < 0.01) with L3 being the most common level in 2010 compared to L4 in 2016. Both preoperative and surgical corrections of sagittal vertical axis were larger towards the end of the study period. The 2-year revision rate due to mechanical failure steadily declined over the study period from 52% in 2010 to 14% for patients treated in 2016, although without statistically significant trend (P = 0.072). In addition, rates of mechanical complications steadily declined over the study period and significant decreasing trends were observed in time trend analyses of overall complications, major complications and rod breakage. Conclusions: We ob

BACKGROUND/AIM: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC).PATIENTS AND METHODS: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing.RESULTS: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing.CONCLUSION: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.

Study design: Single-center, retrospective. Objectives: To assess the restoration of ideal sagittal spine shape in accordance to the Roussouly classification and the effect on postoperative mechanical complications. Summary of background data: Surgical correction of Adult Spinal Deformity is both challenging and complex. The risk of postoperative complications is considerable, especially mechanical complications requiring revision surgery. Attention has been directed toward defining alignment targets in attempts to minimize these risks, and the Roussouly classification has been proposed as a potential surgical aim. Methods: All patients undergoing ASD surgery from 2013–2016 were included at a single, quaternary institute. Successful restoration of Roussouly spine shape was retrospectively assessed, and patients were classified as either “restored” or “non-restored”. Cumulative incidence of revision surgery due to mechanical failure was estimated using the Aalen–Johansen estimator, with death as the competing risk. A multivariable proportional odds model was used to estimate the effect of the Roussouly algorithm on revision surgery due to mechanical failure. Results: We identified a complete and consecutive cohort of 233 patients who were followed for a mean period of 36 (± 14) months. The 2-year cumulative incidence of revision surgery was 28%. Comparing the “restored” to the “non-restored” group, the overall revision rates were high in both groups. However, when adjusting for known cofounders in a multivariable proportional odds analysis, there was an almost fivefold increased odds of revision due to mechanical failure in the “non-restored” group (p = 0.036). Conclusion: Surgical correction of ASD in accordance to the ideal Roussouly spine shape was correlated to a marked and significant decrease in risk of revision surgery due to mechanical failure. Nonetheless, the overall revision risk was elevated in both groups. Level of evidence: Therapeutic III.

STUDY DESIGN: Cross-sectional analyses on a consecutive, prospective cohort.OBJECTIVE: To evaluate the ability of the Scoliosis Research Society (SRS)-Schwab Adult Spinal Deformity Classification to group patients by widely used health-related quality-of-life (HRQOL) scores and examine possible confounding variables.SUMMARY OF BACKGROUND DATA: The SRS-Schwab Adult Spinal Deformity Classification includes sagittal modifiers considered important for HRQOL and the clinical impact of the classification has been validated in patients from the International Spine Study Group database; however, equivocal results were reported for the Pelvic Tilt modifier and potential confounding variables were not evaluated.METHODS: Between March 2013 and May 2014, all adult spinal deformity patients from our outpatient clinic with sufficient radiographs were prospectively enrolled. Analyses of HRQOL variance and post hoc analyses were performed for each SRS-Schwab modifier. Age, history of spine surgery, and aetiology of spinal deformity were considered potential confounders and their influence on the association between SRS-Schwab modifiers and aggregated Oswestry Disability Index (ODI) scores was evaluated with multivariate proportional odds regressions. P values were adjusted for multiple testing.RESULTS: Two hundred ninety-two of 460 eligible patients were included for analyses. The SRS-Schwab Classification significantly discriminated HRQOL scores between normal and abnormal sagittal modifier classifications. Individual grade comparisons showed equivocal results; however, Pelvic Tilt grade + versus + + did not discriminate patients according to any HRQOL score. All modifiers showed significant proportional odds for worse aggregated ODI scores with increasing grade levels and the effects were robust to confounding. However, age group and aetiology had individual significant effects.CONCLUSION: The SRS-Schwab sagittal modifiers reliably grouped p

PURPOSE: To assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression.MATERIALS AND METHODS: This single-blind, randomized (1:1), controlled, parallel-group, single-center trial was approved by the Danish National Committee on Biomedical Research Ethics and was conducted from May 2011-March 2013. Participants (N = 45) were scheduled for decompression and posterior thoracic/lumbar spinal instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat.RESULTS: The intention-to-treat analysis included 45 patients. Mean intraoperative blood loss did not differ significantly (P = .270) between the embolization group (618 mL [SD, 282 mL]) and the control group (735 mL [SD, 415 mL]). There was also no significant difference in allogeneic RBC transfusion (P = .243). Surgery time was significantly shorter in the embolization group (P = .031): median 90 minutes (range, 54-252 min) versus 124 minutes (range, 80-183 min). The subanalysis of hypervascular metastases revealed a significant (P = .041) reduction in blood loss in the embolization group: 645 mL (SD, 289 mL) versus 902 mL (SD, 416 mL).CONCLUSIONS: Preoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction of intraoperative blood loss was shown in hypervascular metastases.