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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Comparative Study
Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) cause significant morbidity and mortality in orthopaedic surgical practice, although the incidence following surgery to the lumbosacral spine is less than following lower limb surgery. Our objective was to compare our rate of thromboembolic complications with those published elsewhere and investigate whether the adoption of additional pharmacological measures reduced the incidence of clinically evident DVT and PE. This retrospective study was undertaken to investigate the incidence of DVT/PE during the 10 years from 1 January 1985 to 31 December 1994, and then to assess the effectiveness of an anticoagulant policy introduced during 1995 using low dose aspirin or LMH in high risk cases. ⋯ A total of 697 operations were performed from 1 January 1985 to 31 December 1994 with two cases of DVT and no cases of PE giving thromboembolic complication rate of 0.29%. During the period 1 January 1996 to 31 December 2003, 414 operations resulted in one case of DVT and no cases of PE, a rate of 0.24%. The incidence of symptomatic thrombo-embolic complications in lumbar spinal surgery is low in the kneeling, seated prone operating position, whether or not anticoagulation is used.
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In advanced stages of degenerative disease of the lumbar spine instrumented spondylodesis is still the golden standard treatment. However, in recent years dynamic stabilisation devices are being implanted to treat the segmental instability due to iatrogenic decompression or segmental degeneration. The purpose of the present study was to investigate the stabilising effect of a classical pedicle screw/rod combination, with a moveable hinge joint connection between the screw and rod allowing one degree of freedom (cosmicMIA). ⋯ A rigid instrumentation (6) further reduced the ROM of the two-bridged segments to 20-30, 23-27 and 50-68% in lateral bending, flexion/extension and axial rotation, respectively. The results of the present study showed that compared to the intact specimen the investigated hinged dynamic stabilisation device reduced the ROM after bisegmental decompression in lateral bending and flexion/extension. Following bisegmental decompression and the thereby caused large rotational instability the device is capable of restoring the motion in axial rotation back to values in the range of the intact motion segments.
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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods -- biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. ⋯ The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low- and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio- and chemotherapy would be sensible to implement.
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An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4-C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2-C7) were tested in flexion/extension, lateral bending, and axial rotation under a +/- 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4-C5 and tested. ⋯ The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting.
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Motor vehicle collision (MVC) is one of the most common causes of thoracolumbar junction (TLJ) injury. Although it is of no doubt that the use of seatbelt reduces the incidence and severity of MVC-induced TLJ injury, how it is protective for front-seat occupants of an automobile after rollover crashes is unclear. Among 200 consecutive patients with a major TLJ (Th11-L2) injury due to high-energy trauma admitted from 2000 to 2004, 22 patients were identified as front-seat occupants of a four-wheel vehicle when a rollover crash occurred. ⋯ It is likely that the high incidence of neurologic deficit in the unbelted group was due to the high incidence of AO type B/C injury. This study indirectly proves the efficacy of seatbelt in reducing the severity of rollover-induced TLJ injury. Because of the limited number of cases, it is uncertain whether ejection from vehicle, which occurs exclusively in the unbelted victims, is a crucial factor in determining the severity or type of injury after rollover crashes.