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AbstractBackgroundObjectiveMethodsResultsConclusionAmbulatory anterior cervical discectomy and fusion (ACDF) is a promising method, but not common in Poland.That is why the purpose of this study was to demonstrate the experience of performing ACDF in patients with degenerative spinal diseases.This study at the Spine Centre involved a single-center, multi-surgeon evaluation of 100 patients undergoing ACDF.Outcomes assessed included pain severity, measured by the visual analogue scale, which improved from 4.28 ± 0.76 preoperatively to 1.11 ± 0.59 one month postoperatively. The Core Outcome Measures Index-neck (COMI-neck) scale also showed significant improvement: before surgery, 30% of patients scored their condition severity between 4-6, and 70% scored 7-10; 6 months postoperatively, the scores were 0-3 for 55% of patients, 4-6 for 45%, and 7-10 for none. Only 2% of patients experienced moderate, temporary complications, with no serious complications or postoperative hematomas observed.The study supports the feasibility, safety, and efficacy of performing ACDF in an ambulatory setting, suggesting that with appropriate patient selection and surgical protocols, ambulatory ACDF can be more broadly implemented. [ABSTRACT FROM AUTHOR]

Background and purpose: Currently no minimally invasive surgical treatment exists to provide immediate stability for unstable cervical/cervicothoracic metastases. Long-construct spondylodesis carries a high complication risk and has severe impact on residual range of motion. This study explores temporary halo fixation and radiotherapy as an alternative to long-construct cervical spondylodesis. Materials and methods: This retrospective cohort study included twenty patients with multiple unstable cervical metastases treated between 2013–2023. All patients underwent halo fixation for an intended duration of three months to allow for safe reossification of lytic lesions following radiotherapy, with a dose fractionation scheme best suited to the histological origin of the tumor. Results: Immobilization with halo fixation lasted a median 83 days (range, 41–132 days). Radiotherapy started on average 7 days after halo fixation (range, −35–118 days). The median pain score at baseline was 8, and was 0 at halo removal and at last follow-up. All patients had no or minor neurological deficits at baseline and did not develop new neurological deficits. At halo removal, 17/18 patients showed radiographic evidence of reossification. The majority of patients experienced minor limitations or had full range of motion of the neck at last follow-up. Conclusion: Patients with multiple unstable cervical metastases treated with halo fixation and radiotherapy showed complete pain response or substantial pain reduction, reossification of the vertebrae and a, mostly, preserved range of motion. In selected neurologically intact patients, this treatment might be a patient-friendly alternative to fixation. Prospective evaluation of this treatment combination is needed.

ObjectiveCervical spondylodiscitis is a rare pathology, with an incidence of 0.5–2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity.MethodsIn this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test.ResultsTwenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised.ConclusionCervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Background: Implant subsidence is recognized as a complication of interbody stabilization, although its relevance remains ambiguous, particularly in terms of relating the effect of the position and depth of subsidence on the clinical outcome of the procedure. This study aimed to evaluate how implant positioning and size influence the incidence and degree of subsidence and to examine their implications for clinical outcomes. Methods: An observational study of 94 patients (157 levels) who underwent ACDF was conducted. Radiological parameters (implant position, implant height, vertebral body height, segmental height and intervertebral height) were assessed. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Subsidence was evaluated in groups according to its degree, and statistical analyses were performed. Results: The findings revealed that implant-to-endplate ratio and implant height were significant risk factors associated with the incidence and degree of subsidence. The incidence of subsidence varied as follows: 34 cases (41.5%) exhibited displacement of the implant into the adjacent endplate by 2–3 mm, 32 cases (39%) by 3–4 mm, 16 cases (19.5%) by ≥4 mm and 75 (47.8%) cases exhibited no subsidence. Conclusions: The findings underscore that oversized or undersized implants relative to the disc space or endplate length elevate the risk and severity of subsidence. [ABSTRACT FROM AUTHOR]

Study Design Retrospective single-center, single-surgeon cohort study. Purpose Our goal was to compare the 2-year clinical and radiological results of artificial disc replacement (ADR) and cage screw (CS) implants in patients with cervical degenerative disc disease (DDD). Overview of Literature Anterior cervical discectomy and fusion with CS implants are an acceptable alternative to traditional cage-plate construct due to perceived decreased complications of dysphagia. However, patients may experience adjacent segment disease because of increased motion and intradiscal pressure. ADR is an alternative to restore the physiological kinematics of the operated disc. Few studies directly compare ADR and CS construct for their efficacy. Methods Patients who received single-level ADR or CS between January 2008 and December 2018 were included. Data collected was preoperatively, intraoperatively, and postoperatively (6, 12, 24 months). Demographic information, surgical information, complications, follow-up surgery, and outcome ratings (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Visual Analog Scale [VAS] neck and arm, 36-item Short Form Health Survey [SF-36], EuroQoL-5 Dimension [EQ-5D]) were gathered. The radiological assessment included motion segment height, adjacent disc height, lordosis, cervical lordosis, T1 slope, the sagittal vertical axis C2–7, and adjacent level ossification development (ALOD). Results Fifty-eight patients were included (ADR: 37 and CS: 21). At 6 months, both groups’ JOA, VAS, NDI, SF-36, and EQ-5D scores significantly improved, and the positive trends persisted at 2 years. Noted no significant difference in the enhancement of clinical scores except for the VAS arm (ADR: 5.95 vs. CS: 3.43, p=0.001). Radiological parameters were comparable except for the progression of ALOD of the subjacent disc (ADR: 29.7% vs. CS: 66.9%, p=0.02). No significant difference in adverse events or severe complications seen. Conclusions ADR and CS obtain good clinical results for symptomatic single-level cervical DDD. ADR demonstrated a significant advantage over CS in the improvement of VAS arm and reduced progression of ALOD of the adjacent lower disc. No statistically significant difference of dysphonia or dysphagia between the two groups were seen, attributed to their comparable zero profile.

The review is based on the analysis of 53 literature sour­ces from PubMed, Google, Google Scholar, and Cochrane Library. Among the substitutes for autogenous bone grafts in spine surgery, ceramic biomaterials are the largest studied group, among which certain niche is occupied by calcium phosphate ceramics (CPCs). Hydroxylapatite, tricalcium phosphate and biphasic ceramics with all parts of hydroxylapatite and tricalcium phosphate are widely used in spine surgery. The advantage of using CPCs is their biocompa­tibility, osteoconductivity, osteoinductivity, osteoimmunomodulation and the ability to stimulate angiogenesis — the main components that ensure bone regeneration. In the given review, the peculiarities of regeneration in the interface “ceramic material — bone tissue” depending on the composition, surface structure, and crystallinity of the material are noted. The positive results of the experimental studies led to the use of CPCs in the clinic. CPCs with auto­genous bone grafts are successfully used in posterior and posterolateral lumbar spondylodesis, which allows reducing significantly the volume of autologous bone. A new direction is the development of non-metallic combined cages, which are used to perform anterior cervical discectomy and spondylodesis. The composition of these cages includes various polymers in combination with CPCs and bone autogenous graft to ensure high-quality spondylodesis, reduce of stress-shiel­ding and subsidence of the cage. A special approach requires the study of degradation and resorption by osteoclasts of various CPCs in order to control and synchronize the process of “resorption — bone formation”. Among the issues for the further research, the molecular mechanisms of osteoimunomodulation and factors that stimulate osseointegration and osteoinduction in the management of reparative osteogenesis should be further explored.

Spondylolisthesis is a pathology of the musculoskeletal system that causes a vertebra to move forward, sideways or backward. Most often, it is treated surgically using transpedicular structures. Objective. To present a clinical case of re-treatment for degenerative lumbar spondylolysis of the LV vertebral body using transpedicular and posterior autografting techniques. Methods. The clinical case of lumbar spine osteochondrosis, spondyloarthritis, posterior transpedicular fusion LV--SI, fracture of the screw in the body of the SI vertebra on the right, and spinal canal stenosis at the level of LV--SI is described. Lower paraparesis. Results. The patient underwent metal removal, decompression of the spinal canal at the level of LV--SI, open reduction of the LV vertebral body, posterior transpedicular fusion of LIV--SI and posterior autografting fusion. The surgical intervention was successful, despite the technical difficulties associated with removing the threaded part of the broken screw. According to the visual analogue scale, the patient had 8 points before the operation, which indicates acute pain syndrome, and after that the pain intensity decreased to 4 points. Muscle strength of the right and left lower extremities before surgery was 2 and 2.5 points, respectively, 5 days after surgery, improvement was recorded -- 3 points for each limb. From the second day after repeated surgical treatment, the patient showed a significant improvement in muscle sensitivity and strength in both lower extremities. Conclusions. The clinical example of repeated surgery due to the failure of the metal structure and the deterioration of the patient's neurological status highlights the need for post-operative follow-up. Taking into account the percentage of complications after transpedicular spondylodesis, it is necessary to continue scientific research to improve the results of surgical treatment of patients with degenerative diseases of the spine. [ABSTRACT FROM AUTHOR]

Introduction and purpose: The aim of this study is to provide a comprehensive description of intervertebral disc herniation, with a focus on the lumbar spine, including the current conservative and modern surgical treatment options such as minimally invasive procedures. State of Knowledge: Spinal pain is a prevalent cause of disability in developed countries, with an increasing number of people affected by this condition. Intervertebral disc herniation resulting from degenerative changes is a common pathology, particularly in the lumbar and cervical spine. This condition involves the protrusion of the nucleus pulposus, which exerts pressure on the spinal roots, causing irritation. While the prognosis for herniated nucleus pulposus is usually positive and many patients can undergo conservative treatment, some may require a surgery. Due to advancements in technology, the current goal is to minimize tissue trauma during hernia repair procedures. Conclusions: Due to advances in treatment of lumbar intervertebral disc herniation, patients can achieve better clinical outcomes and improved quality of life. Conservative treatment should be considered as the first line treatment in a majority of cases. Surgery is usually a last resort when conservative treatment proves insufficient. No surgical method seems to be unequivocally superior to the others, so its choice is tailored to the individual patient's needs and depends on the surgeon's preferences and experience. Recent advances in endoscopic spine surgery are providing new insights into disc surgery and pain management strategies.

Objectives. To compare the survival rate of «bone chip» cells and native transplant automixture by evaluating the architectonics of cell membranes. Material and methods. Autograft in the form of a native graft automixture obtained using a «bone dust filtering device» and «bone chips» obtained using Kerrison rongeurs in 6 patients operated for degenerative diseases of the spine. The study was carried out using a flow cytometer by assessing the architectonics of cell membranes during the first three days. Results. The study of native transplant automixture and «bone chips» determined the dispersed state of the first graft and the latter, similar in its structure to the whole bone. The spectrograms analysis showed a heterogeneous composition of grafts, and in the case of native transplant automixture, the scatter was more pronounced. The increase in the number of cells during the first three days of the native transplant automixture is probably associated with the elimination of contact inhibition of their proliferation and the release of osteoinductive factors from the bone matrix. The number of necrotic cells was higher in the native transplant automixture, which is due to the rough method of its preparation, however, this number was not statistically significant compared to the number of necrotic cells in the «bone chips». Despite the combined thermal and mechanical impact, the survival of the cell component in both cases made up more than 98.0% without any statistical significance in comparison between the two types of transplants (p>0.05). Conclusions. The high survival rate of the cellular component of both types of autografts indicates that the osteogenic potential does not depend on the method of their preparation.

The review is based on the analysis of 53 literature sources from PubMed, Google, Google Scholar, and Cochrane Library. Among the substitutes for autogenous bone grafts in spine surgery, ceramic biomaterials are the largeststudied group, amongwhich certain niche is occupied by calcium phosphate ceramics (CPCs). Hydroxylapatite, tricalcium phosphate and biphasic ceramics with all parts of hydroxylapatite and tricalcium phosphate are widely used in spine surgery. The advantage of using CPCs is their biocompatibility, osteoconductivity, osteoinductivity, osteoimmunomodulation and the ability to stimulate angiogenesis — the main components that ensure bone regeneration. In the given review, the peculiarities of regeneration in the interface “ceramic material — bone tissue” depending on the composition,surface structure, and crystallinity of the material are noted. The positive results of the experimentalstudiesled to the use of CPCsin the clinic. CPCs with autogenous bone grafts are successfully used in posterior and posterolateral lumbar spondylodesis, which allows reducing significantly the volume of autologous bone. A new direction is the development of non-metallic combined cages, which are used to perform anterior cervical discectomy and spondylodesis. The composition of these cagesincludes various polymers in combination with CPCs and bone autogenous graft to ensure high-quality spondylodesis, reduce of stress-shielding and subsidence of the cage. A special approach requires the study of degradation and resorption by osteoclasts of various CPCs in order to control and synchronize the process of “resorption — bone formation”. Among the issues for the further research, the molecular mechanisms of osteoimunomodulation and factorsthatstimulate osseointegration and osteoinduction in the management of reparative osteogenesis should be further explored. [ABSTRACT FROM AUTHOR]

Background and Objectives: Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). Materials and Methods: Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMAHT). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). Results: A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (p = 0.77) but correlated with BMI (p = 0.005). The zSMAHT was significantly lower in patients suffering from an IF (p = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459–13.04, p = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, p = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMAHT (p = 0.0057) and BMD (p = 0.0041) were significantly related to IF occurrence. Conclusion: Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis. [ABSTRACT FROM AUTHOR]

The literature review focuses on artificial intervertebral fusion. An increasing number of instrumented spinal procedures are performed each year with improved diagnostic and treatment strategies, advanced surgical technologies and optimal anesthetic techniques. One of the most common complications of spinal fusion is nonunion with the high reported incidence. Factors affecting fusion rates in lumbar spine surgery are described. Data from articles and textbooks of the last two decades have been used to reflect the current understanding of the research problem including reports in the earlier literature when appropriate.

Abstract Background There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated. Methods We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient’s nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection. Discussion Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs. Trial registration ClinicalTrials.gov, NCT04048304. Registered on 5 August 2019. Protocol version 2, 5 July 2019.

Introduction Despite significant steps in prevention and treatment of infectious complications after surgical treatment on the spine, many issues remain unsolved. There is a sufficient number of scientific reports on the treatment of postoperative infection, however, only a few studies present multivariate analysis of risk factors of developing deep infection after surgical intervention. In the domestic literature, such reports are rare. According to most sources, the rate of infection after spinal interventions ranges from 0.7 to 11.9 %. Material and methods We conducted a retrospective multivariate analysis of the data collected to determine the risk factors of deep surgical infection after spinal surgery at various levels and volumes. To fully determine the risk factors, not only surgical factors were evaluated, but also individual characteristics of patients contributing to the increase in infection rates. The purpose of this study was to compare patients who developed local deep infection after spine surgery, with a randomly selected group of patients who did not develop this complication, to identify modifiable risk factors. Results In the period from 2005 to 2016, we identified 79 cases of postoperative deep infection. The overall morbidity rate after 5564 operations (in 5328 patients) was 1.48 %. The most common causative agent of the infectious process was S. epidermidis MRSE. All patients underwent at least one revision intervention, with additional antibiotic therapy course. To reduce the number of infectious complications in patients at risk, preventive measures were carried out, including changes in the volume and type of surgery, prolonged administration of antibacterial drugs, etc. Of the surgical risk factors, the greatest differences between the groups were noted in the types of surgical interventions, implementation of spondylodesis, and previously performed operations on the spine. Also, the risk of purulent-septic complications increased in high BMI, diabetes and urinary tract infection. Conclusion The conducted multivariate analysis reliably confirms the significance of the risk factors identified.

Background Context: Pseudarthrosis after attempted spinal fusion is yet not sufficiently understood and presents a surgical challenge. Occult infections are sometimes observed in patients with pseudarthrosis and no inflammatory signs of infection. The prevalence of such occult infection and its association with patient demographics and inflammatory markers are largely unknown.Purpose: To determine the prevalence of unexpected low-grade infection in spinal pseudarthrosis revision surgery, and to evaluate whether such infection is associated with patient demographics and inflammatory markers.Study Design: Retrospective observational study.Patient Sample: One-hundred-and-twenty-eight patients who underwent thoracolumbar revision surgery due to presumed aseptic pseudarthrosis after spinal instrumentation.Outcome Measures: Culture-positive infections or noninfectious pseudarthrosis.Methods: Samples were routinely taken for microbiological examination from all adults (n=152) who underwent revision surgery for presumed aseptic thoracolumbar pseudarthrosis between 2014 and 2019. A full intraoperative microbiological workup (at least three intraoperative tissue samples) was done for 128 (84%) patients, and these patients were included in further analyses. Patient characteristics, medical history, inflammatory markers, and perioperative data were compared between those with and without microbiologically-confirmed infection based on samples obtained during pseudarthrosis revision.Results: The microbiological workup confirmed infection in 13 of 128 cases (10.2%). The predominant pathogen was Cutibacterium acnes (46.2%), followed by coagulase-negative staphylococci (38.5%). The presence of infection was associated with the body mass index (30.9±4.7 kg/m2 [infected] vs. 28.2±5.6 kg/m2 [controls], p=.049), surgery in the thoracolumbar region (46% vs. 18%, p=.019), and a slightly higher serum C-reactive protein level on admission (9.4±8.0 mg/L vs. 5.7±7.1 mg/L, p=.031). Occult infection was not associated with age, sex, prior lumbar surgeries, number of fused lumbar levels, American Society of Anesthesiologist score, Charlson Comorbidity Index, presence of diabetes mellitus, and smoking status.Conclusions: Occult infections were found in 10% of patients undergoing pseudarthrosis revision after spinal fusion, even without preoperative clinical suspicion. Occult infection was associated with higher body mass index, fusions including the thoracolumbar junction, and slightly higher C-reactive protein levels. Intraoperative microbiological samples should be routinely obtained to exclude or identify occult infection in all revision surgeries for symptomatic pseudarthrosis of the spine, as this information can be used to guide postoperative antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background: There is debate regarding criteria to select patients for lumbar fusion surgery who have chronic low back pain (CLBP) and corresponding degenerative changes, but without nerve root compression or neurogenic claudication. The aim of this study was to compare patterns in current practice. Method: A total of 143 printed questionnaires containing 51 questions were distributed at the German Spine Societies' (DWG) annual congress, 6–8 December 2018. Results: We received 127 (89%) surveys (64 orthopedic surgeons and 63 neurosurgeons). Excluding the 22% who do not perform lumbar fusion for CLBP, 41.4% reported performing 1–10 lumbar fusion procedures for patients with CLBP per year, 20.2% reported 11–20, 10.1% reported 21–30 and 17.2% reported performing more than 50. A total of 44.9% of surgeons reported treating patients for at least 6–12 months conservatively before considering surgery; 65.6% considered postoperative pain reduction of 50–70% a treatment success; 32.6% of respondents believe that <50% of patients showed good outcomes after fusion in CLBP and only 15.5% believed that 70% or more showed good outcomes. Orthopedic surgeons perform more lumbar fusion surgeries than neurosurgeons (p = 0.05), fuse more lumbar segments than neurosurgeons (p = 0.02) and are more likely to suggest that their patients with CLBP cease smoking preoperatively (p = 0.02). Conclusions: Despite discouraging evidence in the literature, the majority of respondents still perform fusion surgery in patients with CLBP. The use of preoperative diagnostics and tests vary widely among spine surgeons. [ABSTRACT FROM AUTHOR]

The approval of nusinersen for the treatment of spinal muscular atrophy (SMA) has significantly changed the natural history of the disease. Nevertheless, scoliosis secondary to axial muscle weakness occurs at some point in most of patients with SMA and a conventional posterior interlaminar approach for intrathecal administration of nusinersen can be particularly challenging to perform in patients with severe scoliosis and/or previous spine fusion surgeries. We developed a protocol for the administration of nusinersen in pediatric patients, which includes a decision-tree algorithm that categorizes patients according to the estimated technical difficulty for the intrathecal administration. Complex spine patients were defined as those with a Cobb angle greater than 50° and/or a history of spinal surgery, while the rest of patients were considered non-complex. Nusinersen was successfully administered through a conventional non-CT-guided lumbar puncture in all 14 non-complex spine patients (110 out of 110 procedures; 100%). The feasibility of the intrathecal injection in the 15 complex spine patients was assessed by 3D CT. Administration was considered unfeasible in 7 out of these 15 patients according to imaging. In the 8 complex spine patients in whom the administration was considered feasible, conventional non-CT-guided lumbar punctures were successful only in 19 out of 53 procedures (36%). The remaining 34 procedures (64%) were guided by CT scan, all successful. Our work demonstrates that a cut-off point of 50° in Cobb angle and history of spinal surgery can reliably be used to anticipate the need for CT guidance in nusinersen administration. [Display omitted] • We propose a protocol for nusinersen administration with a decision-tree algorithm. • Image-guided lumbar punctures were performed following a low-dose imaging protocol. • The protocol proved to be feasible and safe in a large cohort of pediatric patients. • A 100% success rate was achieved and serious adverse effects were rare. • The algorithm can be used to make treatment decisions about complex spine patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). Materials and Methods: Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMAHT). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). Results: A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (p = 0.77) but correlated with BMI (p = 0.005). The zSMAHT was significantly lower in patients suffering from an IF (p = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459–13.04, p = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, p = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMAHT (p = 0.0057) and BMD (p = 0.0041) were significantly related to IF occurrence. Conclusion: Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis.

Purpose Carry out a comparative study of the effectiveness of surgical treatment of patients with grade I degenerative spondylolisthesis treated with rigid transpedicular and dynamic interlaminar fixation. Material and methods Surgical treatment of patients with grade I degenerative spondylolisthesis at L4 vertebra was reviewed. The inclusion criteria were as follows, L4 spondylolisthesis measuring up to 5 mm; translation of ≤ 3 mm; L4-L5 segmental kyphosis of ≤ 17 degrees, local scoliosis of ≤ 10 degrees, absence of severe osteoporosis (T-score of > – 2.5). Decompression and dynamic stabilization of the spine was produced in group I (n = 24) with Coflex and Interfix implants. Group II included 20 patients who underwent transpedicular fixation and posterolateral spondylodesis. Standard and functional spondylography, MRI were performed for all the cases. Modified Pfirrmann grading system was used to assess intervertebral disk degeneration. L4 vertebral slippage and lumbar lordosis, intervertebral disc height, L4-L5 angle, translation at lumbar flexion/ extension were measured. Results Oswestry Disability Index (ODI) score was insignificantly lower in the group of dynamic fixation. Pain intensity in the leg and the spine was comparable at follow-up. Adjacent segment syndrome was not common in group I and graded not more than Pfirrmann V. Both groups showed slight changes in lumbar lordosis. Advantages of dynamic interlaminar fixation included decrease in surgical trauma, blood loss and surgical time, and lower risk of complications avoiding overstress to adjacent level. Conclusion The use of interlaminar fixation for selective patients with grade I degenerative spondylolisthesis showed advantages over rigid transpedicular fixation. However, further research is needed for extended indications to the fixators to be used for this cohort of patients

Purpose To assess osteoconductive properties of carbon fibre implants used in surgery of spine injuries and disorders. Materials and methods Two clinical cases from a multicentre prospective study on nanostructured carbon fibrous implants applied for a variety of spinal pathology are presented. Results The usage of highly porous carbon fibre implant resulted in bone and carbon fusion in the clinical instances whereas implants with a residual porosity of 7–12 % showed no fusion between bone and carbon. The patients had satisfactory clinical condition and quality of life. Discussion Carbon fibrous implant characteristics are close to those of bone tissue, being inert and osteoconductive along with high mechanical strength that ensure bone and carbon fibrous fusion with highly porous implant

Background and Objective: Musculature affected during spondylodesis surgery may benefit and recover faster if supported by spine orthosis postoperatively.Methods: This prospective study included 50 consecutive patients undergoing one- or two-level spondylodesis. The intervention group received a lumbar spine orthosis (n= 23), while the control group remained without orthosis (n= 27). Patients were assessed for pain (Visual Analogue Scale, VAS), Oswestry Disability index (ODI) as well as the use of analgesics.Results: Patients wearing an orthosis postoperatively reported a higher degree of subjective stability. However, both intervention as well as control group did not show any significant differences for each of the follow-up points regarding VAS, ODI or the use of analgesics.Conclusion: Wearing an orthosis has neither impact on subjective pain, the need for analgesics nor for postoperative functionality. However, patients reported that they profited from wearing the orthosis by feeling more stable, thereby nicely improving their postoperative mobility. Thus, novel patient reported outcome measures have to be developed to assess these features in future studies. [ABSTRACT FROM AUTHOR]

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Screw loosening is a major complication following spondylodesis. While several modifications increase screw stability, some, such as screw augmentation, are associated with potential complications; new techniques are needed to minimize the risk of screw loosening without increasing complication rates. 13 fresh-frozen human lumbar vertebral bodies (L1 to L5) were dissected. In group 1 (n = 7), pedicle screws were implanted conventionally, while in group 2 (n = 6), the screws were positioned divergent in the sagittal pathway. Screw stability was tested under cyclic axial load; one testing-cycle included 1000 repetitions. The first cycle started with a load of 100 N while the load was increased by +20 N in each following cycle until failure. Failure was defined by either a >5 mm movement of the screw heads or triggering of the switch-off threshold. Average number of cycles until failure was increased in group 2 compared with group 1 (12,046 vs 9761 cycles), as was the average load to failure (Fmax 313 N vs 260 N). Overall, in group 2, the number of cycles until screw loosening or failure increased by 23% (p = 0.28), while the required force increased by 20% (p = 0.3). Statistically significant correlation between BMD and increased number of cycles completed as well as with increased load (p < 0.01) could be observed. The results demonstrate, that divergent screw-drift of pairs of screws in the sagittal plane tends to increase stability, especially in vertebral bodies with lower bone density. Moreover, we could demonstrate a correlation between BMD and stability of screw-fixation. • Lumbar parallel screw fixation is commonly used for strength and stability. • This study tested a new, diverging screw fixation technique. • Fresh-frozen vertebral bodies were used to compare parallel and diverging screw fixation. • Diverging screw fixation tends to offer more strength and stability in poor bone-quality. [ABSTRACT FROM AUTHOR]

Background: There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated.Methods: We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient's nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection.Discussion: Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs.Trial Registration: ClinicalTrials.gov, NCT04048304. Registered on 5 August 2019.Protocol Version: 2, 5 July 2019. [ABSTRACT FROM AUTHOR]

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Bicortical screw fixation is an established technique to increase screw strength in vertebral bodies, although it is associated with several complications, for example screw-loosening. Cement augmentation can increase stability of screw-fixation but can also cause various complications, such as cement-leakage or cement embolism. In this study, we tested a new, multicortical screw fixation technique in the sacrum. Four fresh-frozen sacrums were used. In group 1, standard screw insertion, with sagittal parallel and axial convergent screw-drive was performed. In group 2, the screw-drive of the first screw was similar to the screw-drive in group 1. In addition, a second screw was inserted descending into the intended hole in the head of the screw and at a stable angle. Therefore, the screws of the multiloc humerus nail-system (Synthes) were used. The specimens were connected to a testing-machine and underwent cyclic axial loading with an increase in the load after each completed stage. Multicortical screw fixation leads to a significant increase in the number of completed cycles and a significantly increased load until failure. Multicortical screw fixation in the sacrum offers a stronger attachment of the screws. In the future, multicortical implants, which fulfil the criteria demanded in spine surgery, can offer higher stability and may decrease the loosening rates of the implanted screws. • Sacral bicortical screw fixation is commonly used for strength and stability. • This study tested a new, multicortical screw fixation technique. • Fresh-frozen sacrums were used to compare bicortical and multicortical techniques. • Multicortical screw fixation resulted in more strength, stability and load bearing. [ABSTRACT FROM AUTHOR]

Copyright of Travma is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective We report on our experiences of navigated posterior C1'C2 spondylodesis in the elderly (≥ 70 years of age). Patients This retrospective cohort study evaluated all patients ≥ 70 years of age treated with navigated posterior spondylodesis C1-C2 (at themost to C3) from 2008 to 2015 with a minimum follow-up of 1 year. Minor and major complications within 30 days after surgery, patient outcome, and the rate of solid fusion in computed tomography were recorded. The follow-up over 1 year was conducted by outpatient examinations and via telephone interviews. Results Twenty-two patients with amean age of 79.9 years (range: 71'91 years) were treated. Minor complications were mild pneumonia (18.2%), postoperative confusion (9.1%), and urinary tract infection (4.5%). Major complications were severe pneumonia (4.5%) and clinically asymptomatic vertebral artery injury (4.5%). The mortality rate was 13.6% (n = 3) within the first 30 days after surgery and 22.7% (n = 5) within 1 year. All deceased patients were > 85 years of age. Conclusion In our patient population, posterior spondylodesis was shown to be beneficial for patients > 70 years up to age ~ 85 years. The mortality rate increased sharply in patients > 85 years. In these patients the indication for surgery should be critically evaluated. [ABSTRACT FROM AUTHOR]

Copyright of Rheuma Plus is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Paget's disease of bone (PDB) is a common skeletal disorder that is associated with locally increased bone turnover, skeletal deformity and pain. We report a case of skeletal dissemination in PDB of the spine.Methods: Case report.Results: A 46-year-old former professional athlete suffered from disseminated PDB throughout the spine and hips after various surgical interventions including spondylodesis, bone grafting and bone morphogenetic protein (rhBMP-2) administration. Only intravenous zoledronic acid prevented the further progression of skeletal dissemination, which was expressed by a normalization of (bone-specific) alkaline phosphatase levels. The biopsy obtained from the lumbar spine confirmed the diagnosis of PDB in the absence of malignant transformation.Conclusions: We outline skeletal dissemination as a possibly surgery-related complication in a patient with PDB in the lumbar spine. Bisphosphonates remain the treatment of first choice in PDB and surgical interventions should be considered very carefully. [ABSTRACT FROM AUTHOR]

Hintergrund: Die adulte spinale Deformität (ASD) ist eine meist progrediente Erkrankung, die insbesondere zu chronischen Schmerzen führen kann. Aufgrund der Häufung im Alter leidet ein Großteil der Patienten zudem unter Komorbiditäten, welche die Behandlung dieser Patienten sowohl konservativ als auch operativ komplexer werden lässt.Ziel der Arbeit: Dieser Artikel soll einen Überblick über die aktuellen konservativen sowie auch operativen Therapiemöglichkeiten geben.Material und Methoden: Es erfolgte eine ausführliche Literaturrecherche über Medline sowie das Zusammentragen der persönlichen Erfahrungen der Autoren.Ergebnisse: Die aktuellen konservativen sowie auch operativen Therapien werden dargelegt und potenzielle Risikofaktoren bzw. Prädiktoren, die ein unterdurchschnittliches klinisches Ergebnis erwarten lassen können, diskutiert.Diskussion: Patienten, bei denen auch die konservative Therapie zum Ziel führt, sollten früher und besser identifiziert werden können. Die operative Therapie reicht von wenig invasiven Dekompressionen bis zu langstreckigen Fusionen. Die im Rahmen großer korrektiver Eingriffe auftretenden Komplikationen können erheblich sein, allerdings führt auch eine komplexe operative Therapie bei richtiger Indikationsstellung zu sehr guten Ergebnissen im Hinblick auf die Schmerzsymptomatik und die Lebensqualität. [ABSTRACT FROM AUTHOR]

At RSPC of traumatology and orthopaedic surgery and Institute of powders metallurgic porous implants are working out which allow complitely replace alio- and autotranplants and improve the surgical technology of interbody spondylodesis. Porous implants, made from mechanic durabilities, are bioinert or biocompatible materials, provide durabilities prime spondylodesis. It doesn't need an additional fixation, realize a possibility to grow a bone matter in powder structure of implants.

Background: Nusinersen is an intrathecally administered antisense oligonucleotide (ASO) and the first approved drug for the treatment of spinal muscular atrophy (SMA). However, progressive neuromyopathic scoliosis and the presence of spondylodesis can impede lumbar punctures in SMA patients. Our aim was to assess the feasibility and safety of the treatment in adults with SMA. Methods: For the intrathecal administration of nusinersen, we performed conventional, fluoroscopy-assisted and computer tomography (CT)-guided lumbar punctures in adult patients with type 2 and type 3 SMA. We documented any reported adverse events and performed blood tests. Results: We treated a total of 28 adult SMA patients (9 patients with SMA type 2 and 19 patients with SMA type 3) aged between 18–61 years with nusinersen. The mean Revised Upper Limb Module (RULM) score at baseline in SMA type 2 and SMA type 3 patients was 9.9 ± 4.6 and 29.5 ± 8.5, respectively. The mean Hammersmith Functional Motor Scale Expanded (HFMSE) score at baseline was 3.1 ± 2.5 and 31.2 ± 18.1, respectively. Half of the SMA type 3 patients were ambulatory at treatment onset. In total, we performed 122 lumbar punctures with 120 successful intrathecal administrations of nusinersen. Lumbar punctures were well tolerated, and no serious adverse events occurred. Conclusions: Our data demonstrate the feasibility and tolerability of intrathecal treatment with nusinersen in adults with SMA type 2 and type 3. However, treatment can be medically and logistically challenging, particularly in patients with SMA type 2 and in patients with spondylodesis. [ABSTRACT FROM AUTHOR]

Surgical correction of fixed thoracolumbar deformity is usually achieved by estimating the preoperatively planned correction angles during surgery and is therefore prone to inaccuracy. This is particularly problematic in biplanar deformities. To overcome these difficulties, 3D model for planning, preparation, and simulation of an asymmetric pedicle subtraction osteotomy (aPSO) was printed and used to realign coronal and sagittal balance in case of rigid degenerative kyphoscoliosis. A 59-year-old woman presented with severe back pain and spinal claudication and was diagnosed with a rigid kyphoscoliosis with multilevel spinal stenosis. Spino-pelvic parameters were measured preoperatively (pelvic incidence 47° [PI], lumbar lordosis 18° [LL]; pelvic tilt 42° [PT], T1 pelvic angle 40° [TPA], Cobb angle 33°, sagittal vertical axis 10.5 cm [SVA]). To aid the complex deformity in the sagittal and coronal plane, a 1:1 3D model of the spine was printed according to the preoperative computed tomography (CT). With the use of a rebalancing software, the spine was prepared in vitro as a model for intraoperative realignment and the correction was preoperatively simulated. Surgery was accomplished according to the preoperative software-guided plan. Asymmetric pedicle subtraction osteotomy (aPSO) of L3 identical to the 3D model was performed. Additionally, a Smith-Peterson osteotomy of L4/5 with transforaminal lumbar interbody fusion (TLIF) and laminectomy of L2-S1 with pedicle screw instrumentation TH12-S1 was accomplished. Postoperative radiological parameters revealed good success (LL 40°, SVA 6 cm, PT 19°, TPA 22°, and a Cobb angle of 8°). Improvement of the Oswestry disability index (ODI) of 42 to 18, the visual analog scale (VAS) of 8 to 1, and walking distance 100 to 8000 m compared to preoperatively resulted at 24 months follow-up. The precise coronal and sagittal correction of a rigid degenerative kyphoscoliosis presents a major challenge. Asymmetric PSO is able to realign the thoracolumbar spine in both the coronal and sagittal planes. The creation of an in vitro 3D-printed model of a patient's spinal deformity in combination with a software to calculate the correction angles facilitates preoperative planning and implementation of aPSO. [ABSTRACT FROM AUTHOR]

Background The number and cost of instrumented spinal fusion surgeries have increased rapidly, primarily for the treatment of lumbar segmental instabilities. However, what if the organism itself is able to restore segmental stability over time? This large-animal study using sheep aimed to investigate whether the reparative response after destabilization via facetectomy and nucleotomy without instrumentation can effectively fuse the spinal segment comparable to instrumented standard fusion surgery. Methods The following four surgical interventions were investigated: dorsal fixation via internal fixator, ventral fixation via cage as well as facetectomy and nucleotomy without additional instrumentation. Six months postoperatively, the animals were sacrificed, and the lumbar spines were used for biomechanical tests. Findings Spinal stability was restored to the destabilized spinal segments at six months postoperatively and was comparable to the results of conventional surgery via screws and cages. Iatrogenic hypomobilization caused significant reductions in facet joint space and intervertebral disc height of segments at index and adjacent level. Restabilized segments after iatrogenic hypermobilzation also significantly decreased facet joint space and disc height at index level, but revealed no influence on adjacent segments. Interpretation These findings in the sheep model question the necessity of costly instrumentation and suggest the alternative possibility of stimulating the reparative capacity of the body in human lumbar spine fusion surgery. [ABSTRACT FROM AUTHOR]

Introduction: PMMA-augmentation of pedicle screws strengthens the bone-screw-interface reducing cut-out risk. Injection of fluid cement bears a higher risk of extravasation, with difficulty of application because of inconsistent viscosity and limited injection time.Objective: To test a new method of cement augmentation of pedicle screws using radiofrequency-activated PMMA, which is suspected to be easier to apply and have less extravasations.Methods: Twenty-seven fresh-frozen human cadaver lumbar spines were divided into 18 osteoporotic (BMD ≤ 0.8 g/cm2) and 9 non-osteoporotic (BMD > 0.8 g/cm2) vertebral bodies. Bipedicular cannulated pedicle screws were implanted into the vertebral bodies; right screws were augmented with ultra-high viscosity PMMA, whereas un-cemented left pedicle screws served as negative controls. Cement distribution was controlled with fluoroscopy and CT scans. Axial pullout forces of the screws were measured with a material testing machine, and results were analyzed statistically.Results: Fluoroscopy and CT scans showed that in all cases an adequately big cement depot with homogenous form and no signs of extravasation was injected. Pullout forces showed significant differences (p < 0.001) between the augmented and non-augmented pedicle screws for bone densities below 0.8 g/cm2 (661.9 N ± 439) and over 0.8 g/cm2 (744.9 N ± 415).Conclusions: Pullout-forces were significantly increased in osteoporotic as well as in non-osteoporotic vertebral bodies without a significant difference between these groups using this standardized, simple procedure with increased control and less complications like extravasation. [ABSTRACT FROM AUTHOR]

Even low-energy trauma can lead to serious fractures of the spine in patients with ankylosing spondylitis (AS). These patients have a greater risk of suffering from neurological impairment and this can also occur after a delay of several days. Newly occurring back pain in AS patients without any recognized trauma should be treated as a fracture unless proven otherwise. This highlights the importance of accurate clinical and radiological examinations, which should be repeated at short intervals, especially if the patient complains of indefinable pain or shows neurological symptoms. Simple X-ray examinations of the spine are usually not sufficient to exclude a fracture, particularly in the junction zones. A computed tomography (CT) scan should be carried out in any case and if in doubt, magnetic resonance imaging (MRI) in fat-suppressed short inversion time inversion recovery (STIR) weighting should also be performed. Surgical treatment of AS injuries is the safest and most effective method of treatment. Immediate stabilization of the fracture site enables early mobilization, which can avoid the risk of complications due to longer immobilization. In addition, in this way the neurological status can be effectively improved. Nevertheless, the surgical treatment of cervical spine fractures in AS is very challenging. The primary surgical procedure of choice is posterior long segment spinal fusion. Due to kyphotic deformities and risk of pulmonary and cardiac comorbidities, primary ventral plating is usually not indicated. If the posterior fusion is long enough, there is usually no need for an additional secondary anterior procedure. [ABSTRACT FROM AUTHOR]

Approximately 30% of all type II dens fractures according to Anderson and D'Alonzo are accompanied by translational atlantoaxial instability. Whilst these comparatively rare injuries are observed as a result of high speed trauma in younger people, they also occur after low energy impact trauma in elderly patients, e. g. after falls. The sagittal reconstruction using a computed tomography (CT) scan of the dens is decisive as it accurately displays the frequent dorsal dislocation combined with atlantoaxial dislocation or subluxation. In all 30 cases of such injuries analyzed, translational atlantoaxial instability with posterior dislocation of C1-2 was present, in part with additional rotational instability. Avulsion fractures or rupture of the transverse ligament were not found in any of these cases. Anterior screw fixation of the odontoid process alone is insufficient when combined with segmental C1-2 instability. If anterior screw fixation is possible in elderly patients after repositioning of the dens fracture, the C1-2 joint and temporary retention, anterior transfixation of the C1-2 joint using the approach by Barbour and anterior screw fixation of the dens axis are recommended due to the empirically lower access morbidity. A posterior approach is recommended in young patients as reduction of the C1-2 joint and the dens fracture is achieved more easily and posterior fusion is possible. [ABSTRACT FROM AUTHOR]

BACKGROUND: Goal of this study is to present an easily reproducible and reliable measurement to evaluate accuracy of screw placement in cervical spine. METHODS: Accuracy of cervical screw position was assessed in 52 patients treated with 163 screws. Each patient receiving pedicle, transarticular C1/2, lateral mass, or laminar screws and postoperative CT scan was included. Placement position was categorized in 5 grades: Grade 1 is ideal with pedicle wall perforation < 1 mm, grade 2 < 2 mm, grade 3 < 3 mm, and grade 4 < 4 mm. Grade 5 > 4 mm and/or obstruction of transverse foramen by more than half a screw diameter. Intraclass correlation coefficient (ICC) values were assessed for inter- and intraobserver reliability. RESULTS: The mode of individual evaluations was calculated to assign a single value to each screw. This yielded 89 grade 1 (54.6%), 48 grade 2 (29.4%), 14 grade 3 (8.6%), 3 grade 4 (1.8%), and 9 grade 5 (5.5%) screws. Intraobserver reliability ICC was 0.966 and 0.959 for measurements. Interobserver reliability ICC was 0.938. CONCLUSION: This study introduces a reliable classification of cervical spine instrumentation with various screw types. This should enable the use of a uniform and reproducible, and thus comparable classification for screw position in cervical spine. [ABSTRACT FROM AUTHOR]

Background: Smoking is a risk factor in the process of bone healing after lumbar spondylodesis, often associated with complications that occur intraoperatively or during follow-up periods.Objective: To assess if smokers yield worse results concerning lumbar interbody fusion than non-smokers in a clinical comparative setting.Methods: Spondylodesis outcomes in 50 patients, 34 non-smokers (mean 58 years; (range 29-81) and 16 smokers (mean 47 years; range 29-75) were compared preoperatively and one year after spondylodesis surgery using Oswestry-Disability-Index (ODI), visual analogue scale (VAS) and radiological outcome analysis of fusion-success.Results: Smokers showed a comparable ODI-improvement (p = 0.9343) and pain reduction to non-smokers (p = 0.5451). The intake of opioids was only reduced in non-smokers one year after surgery. Fusion success was significantly better in non-smokers (p = 0.01).Conclusions: The results indicate that smoking adversely effects spinal fusion. Particularly re-operations caused by pseudarthrosis occur at a higher rate in smokers than in non-smokers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study was to analyze clinical and radiographic outcomes of operative management of L5 high-grade dysplastic spondylolisthesis with the apparatus for external transpedicular fixation (AETF), and to compare the results of its use for reduction and spondylodesis.Methods: There were 13 patients with L5 dysplastic spondylolisthesis of grade 4 (Meyerding grading) and having a mean age of 25.0 ± 3.6 years. The management included two stages: gradual reduction with the AETF, followed by either isolated anterior spondylodesis with the same AETF (group 1, n = 8), or by spondylodesis using a combined method (internal transpedicular instrumentation and posterior lumbar interbody fusion [PLIF]) (group 2, n = 5). Clinical evaluation included pain (VAS scale) and functional status (Oswestry questionnaire [ODI]). Reduction and fusion completeness were assessed radiographically after treatment and at a mean follow-up of 2.1 ± 0.4 years.Results: Initial slippage was reduced by 51.6 % with AETF and was of grade 1 or 2. Reduction made up 31.1 % at follow-ups (grade 2 or 3). Pain decreased by 57.6 % (p < 0.01). The functional status improved. ODI decreased by 37.7 % (p < 0.01) after treatment and by 41.7 % (p < 0.01) at follow-ups. Fusion at the level of the involved segment was poor in group 1. All the cases fused in group 2.Conclusions: The use of AETF for L5 high-grade dysplastic spondylolisthesis provides gradual controlled reduction of the slipped vertebra, decompression of cauda equine roots, and recovery of the local sagittal spinal column balance. It creates conditions for achieving stability of lumbosacral segments with combined spondylodesis (internal transpedicular instrumentation and PLIF). AETF is not suitable for spondylodesis due to a high rate of pseudarthrosis. [ABSTRACT FROM AUTHOR]

Non-fusion spinal implants are designed to reduce the commonly occurring risks and complications of spinal fusion surgery, e.g. long duration of surgery, high blood loss, screw loosening and adjacent segment disease, by dynamic or movement preserving approaches. This principle could be shown for interspinous spacers, cervical and lumbar total disc replacement and dynamic stabilization; however, due to the continuing high rate of revision surgery, the indications for surgery require as much attention and evidence as comparative data on the surgical technique itself. [ABSTRACT FROM AUTHOR]

Background: Pyogenic infections of the lumbar spine are a rare but critical pathology, yet with considerably high mortality rates. In cases indicating surgical therapy, the implantation of titanium cages or autologous bone grafts represent today's gold standard. Although non-metallic implants such as poly-ether-ether-ketone (PEEK) have proven to be advantageous in diverse degenerative conditions, their safety and practicability in lumbar spine infection remains questionable. Moreover, the efficacy of a single-step radical debridement of the infected disc space with subsequent fusion from a strictly posterior approach continues to be an issue of debate. We therefore sought to evaluate the feasibility, clinical and radiological outcome of a single-step TLIF procedure using oblique PEEK cages in the surgical management of patients with lumbar pyogenic spondylodiscitis. Methods: From January 2009 through December 2013, all patients meeting the indication for surgical treatment of lumbar pyogenic spondylodiscitis were included. Patients demonstrating intact cortical bone on preoperative CT received a single-step radical debridement of the infected intervertebral disc space, posterior screw-and-rod instrumentation and implantation of an oblique PEEK cage using the TLIF technique. Oral antibiotics were continued for 12 weeks postoperatively and clinical and radiological results recorded throughout a minimum 1-year clinical follow-up. Results: A total of 104 patients were admitted to receive surgical therapy for lumbar pyogenic spondylodiscitis. Within this patient population, 18 patients met the diagnostic criteria to receive the implantation of an oblique PEEK cage. Pathogens were detected in 13 cases with Staph. aureus being the predominant causative organism. All patients were discharged to recover in their domestic environment. Throughout the first year of clinical and radiological follow-up and beyond, none of the 18 patients demonstrated any signs of residual neurologic deficits or recurrent infection. Furthermore, two-plane conventional X-rays showed no significant implant subsidence or failure at any of the given time-points in up to 5 years postoperatively. Conclusions: In patients meeting the criteria for surgical treatment of lumbar pyogenic spondylodiscitis, the implantation of PEEK cages using a single-step TLIF approach is a safe and feasible procedure. Based on our experience, the concern of a recurrent infection when implanting non-metallic cages may be refuted in carefully selected patients. [ABSTRACT FROM AUTHOR]

Fractures of the thoracic and lumbar spine result from high velocity trauma, assuming bone density is normal. The main location of fractures is the thoracolumbar junction. Most injuries can be treated conservatively; however, patients transferred to hospitals and spine centers represent a preselection with more severe trauma and a higher incidence of operative treatment. There is a large variety of operative techniques that can be used, which can be principally differentiated by the approach: posterior or anterior. Dorsal approaches are differentiated by the instrumentation for spondylodesis as open or percutaneous techniques. Minimally invasive options are favored more and more. For osteoporotic bone, cement augmented solutions may be used. Correct reduction of mainly kyphotic malalignment is crucial for the long-term outcome. Biomechanically stable reconstruction of the anterior spinal column is important mainly for the thoracolumbar junction. [ABSTRACT FROM AUTHOR]