European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Case Reports
Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature.
A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evacuate her bladder and control her micturition. ⋯ A self-catheterisation regime was instituted with a diagnosis of parasympathetic nerve injury during the anterior spinal fusion. After a period of 3 months, the patient regained control of urination. We report this case to highlight the importance of protecting the parasympathetic presacral nerve during L5-S1 anterior interbody fusion, as injury to this nerve affects urinary evacuation.
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In this study a series of 32 patients with idiopathic scoliosis, managed with selective thoracic fusion, was reviewed. Classified according to King and instrumented with the H-frame, the patients were evaluated for curve correction, rib hump correction and postoperative shift in lumbar rotation. Age and follow-up average 19.4 and 2.4 years, respectively. ⋯ This en bloc rotation of the unfused lumbar segments is induced by the correcting forces applied by the instrumentation. The unfused lumbar spine of a patient with a King type II curve shows a larger lumbar rotation shift and subsequent rib hump correction than that of a patient with a King type III curve. Together with factors such as lateral angulation, rib-vertebra angles and structural limitations, the rotational dynamics of the unfused lumbar spine seem to form an important component in the under-standing and surgical management of scoliosis.
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Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979-1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. ⋯ The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.
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Chronic contained rupture of an abdominal aortic aneurysm is rare. These aneurysms are small and affected patients are usually normotensive. ⋯ Diagnosis is often delayed as the condition may present with symptoms referable to the lumbar spine. This report is of two cases where the initial diagnosis was infective spondylitis.