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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The study design is retrospective. The aim is to describe our experience about the treatment of patients with neuromuscular scoliosis (NMS) using Cotrel-Dubousset instrumentation. Neuromuscular scoliosis are difficult deformities to treat. ⋯ Major complications affected 8.3% of patients, and included 1 postoperative death and 1 deep infection. Minor complications affected none of patients. CD technique provides lasting correction of spinal deformity in patients with neuromuscular scoliosis, with a lower complications rate compared to reports on second-generation instrumented spinal fusion.
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Percutaneous techniques may be helpful to reduce approach-related morbidity of conventional open surgery. The aim of the study was to evaluate the feasibility and safety of mini-open posterior lumbar interbody fusion for instabilities and degenerative disc diseases. From May 2005 until October 2008, 20 patients affected by monosegmental instability and disc herniation underwent mini-open lumbar interbody fusion combined with percutaneous pedicle screw fixation of the lumbar spine. ⋯ At 24-month follow-up, the mean VAS score was 2.1, mean ODI was 27.1%, and mean SF-36 was 85.2%. 80 screws were implanted in 20 patients. 74 screws showed very good position, 5 screws acceptable, and 1 screw unacceptable. A solid fusion was achieved in 17 patients (85%). In our opinion, mini-open TLIF is a valid and safe treatment of lumbar instability and degenerative disc diseases in order to obtain faster return to daily activities.
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Iatrogenic spinal cord injury is the most feared complication of scoliosis surgery. The importance of combined somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) monitoring during spine surgery is well known. The current authors retrospectively evaluated the results of neurophysiological intraoperative monitoring (IOM) in a large population of patients who underwent surgical treatment for spinal deformity. ⋯ When combined SEP and TES-MEP monitoring was performed, the sensitivity and specificity of IOM for sensory-motor impairment was 100 and 98%, respectively. Combined SEP and TES-MEP monitoring must be regarded as the neurophysiological standard for intraoperative detection of emerging spinal cord injury during corrective spinal deformity surgery. Early detection affords the surgical team an opportunity to perform rapid intervention to prevent injury progression or possibly to reverse impending neurologic sequelae.
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This study is a retrospective case series review of patients with adolescent idiopathic scoliosis (AIS) who were revised more than 1 year after the index procedure, due to a late-developing deep wound infection, to determine onset, bacteriology, possible influence of implant alloy (titanium vs. stainless-steel) and treatment outcome of patients. From a total of 540 patients who underwent posterior-only fusion for AIS from 1993 through 2005 at our institution, 15 cases (2.77%) were revised due to a late-developing post-operative infection: there were six males and nine females, with an average age at initial surgery of 15.8 years (range 12-18). Late infections occurred at a mean of 70 months (15-95) after the index procedure. ⋯ None presented at latest follow-up scoliosis progression: there was no statistically significant difference between final and pre-operative revision surgery values (P = 0.17). In conclusion, treatment of late-developing post-operative infection in AIS surgery required complete removal of the implant, continuous drain and adequate antibiotic therapy based on intraoperative swab antibiogram. Titanium alloy instrumentations resulted less subject to late post-operative infections, when compared to stainless-steel ones (P < 0.0001).
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Over the last few years, some hemocomponents have been used advantageously in clinical neurosurgical practice, not systemically via transfusion but topically as a sealant (fibrin glue). This has diverted the attention of many authors to the role of platelets in the healing process. The combination of hyper-concentrated platelets and fibrin glue (fibrinogen, XIII factor, fibronectin) with activated thrombin produces a platelet gel that can be easily applied to "difficult" wounds. ⋯ Bony neoformation after posterior-lateral arthrodesis is well-evident 3 months after surgery and usually continues gradually for the following 18-24 months. The autologous platelet preparation used seems to accelerate bony deposition and to promote tissue healing, increasing bone density at the level of posterior-lateral arthrodesis. Moreover, this preparation has low production costs and is easy to apply.