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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Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) can replace autogenous bone grafting in single-level lumbar interbody fusion. Its use is associated with a higher initial price for the intervention; 2,970 euros in Germany, 2,950 euros in France and 2,266 euros (1,790 pounds sterling) in UK. The aim of this study was to calculate the financial impact of rhBMP-2 treatment in Germany, UK and France from a societal perspective with a two-year time horizon. ⋯ The savings are mainly achieved by reduced productivity loss due to faster return-to-work time for patients treated with rhBMP-2. Use of rhBMP-2 in anterior lumbar fusion is a net cost-saving treatment from a societal perspective for Germany, France and UK. Improved clinical outcome for the patient combined with better health-economic outcome for the society support rhBMP-2 as a valuable alternative compared with autograft.
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Grob et al. (Eur Spine J 5:281-285, 1996) illustrated a new fixation technique in inveterate cases of grade 2-3 spondylolisthesis (degenerative or spondylolytic): a fusion without reduction of the spondylolisthesis. Fixation of the segment was achieved by two cancellous bone screws inserted bilaterally through the pedicles of the lower vertebra into the body of the upper slipped vertebra. Since 1998 we have been using this technique according to the authors' indications: symptomatic spondylolisthesis with at least 25% anterior slippage and advanced disc degeneration. ⋯ No cases of pseudoarthrosis and immediate or late superficial or deep infection were observed. The analysis of the long-term results of the spondylolisthesis surgical treatment with direct pediculo-body screw fixation and postero-lateral fusion gave a very satisfactory response. The technique is reliable in allowing an optimal primary stability, creating the best biomechanical conditions to obtain a solid fusion.
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The most common cervical abnormality associated with rheumatoid arthritis (RA) is atlantoaxial subluxation, and atlantoaxial transarticular screw fixation has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation. Following C1-C2 fixation, however, subaxial subluxation reportedly can bring about neurological deterioration and require secondary operative interventions. Rheumatoid patients appear to have a higher risk, but there has been no systematic comparison between rheumatoid and non-rheumatoid patients. ⋯ Furthermore, anterior subluxation aggravation was significantly correlated with the perioperative atlantoaxial and C2-C7 angle changes, and these two changes were strongly correlated to each other. In conclusion, after atlantoaxial transarticular screw fixation, rheumatoid patients have a greater risk of developing subaxial subluxations. The increase of the atlantoaxial angel at the operation can lead to a decrease in the C2-C7 angle, followed by anterior subluxation of the upper cervical spine and possibly neurological deterioration.
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The classification system of spondylolisthesis proposed by Marchetti and Bartolozzi is the most practical regarding prognosis and treatment and includes the description of both low- and high-dysplastic developmental spondylolisthesis (HDDS). Unfortunately, it does not provide strict criteria on how to differentiate between these two subtypes. The accepted treatment for HDDS is surgical. ⋯ Early identification and stabilization of this challenging surgical entity could prevent the progression of slip and deformity making the index surgery less technically demanding. Vertebrae that are contained in the unstable zone can be instrumented and stabilized so that progression of the deformity and re-operation might be avoided. The authors suggested surgical technique can provide a way to restore sagittal balance, provide an environment for successful fusion, and decrease the risk of iatrogenic L5 neurologic injury.
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The objective of this study was to analyse the presentation, aetiology, conservative management, and outcome of non-tuberculous pyogenic spinal infection in adults. We performed a retrospective review of 56 patients (35 women and 21 men) of pyogenic spinal infection presenting over a 7-year period (1999-2006) to the Department of Spinal Surgery of Hesperia Hospital. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed. ⋯ The follow-up MR gadolinium scans were essential to monitor the response to medical treatment. The diagnosis of pyogenic spinal infection should be considered in any patient presenting with severe localised unremitting back and neck pain, especially when accompanied with systemic features, such as fever and weight loss and in the presence of elevated inflammatory markers. The conservative management of infection with antibiotic therapy and spinal bracing was very successful.