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The radiological outcome of lumbar spinal fusion using a South African-developed dynamic spinal fixation system.

OBJECTIVES: To investigate the radiological outcome of the use of a new Cape Town-developed spinal fixation system. DESIGN: One hundred and fifty-five patients underwent posterior lumbar spinal fusions with this fixation system and autogenous bone graft more than a year ago. Of these 121 were available for radiological follow-up. SETTING: Spinal pedicle fixation systems are in common use in spinal fusion surgery. Most systems use rigid screws with a high rate of implant failure. In South Africa most spinal implants are imported and expensive, and this prompted the development of a locally ma

Lumbar spinal stenosis in an elderly patient.

BACKGROUND: The general population is aging, and lumbar stenosis is one of the more frequent conditions observed in an orthopedic or neurosurgical practice. METHODS: This case presentation is of an 86-year-old male who developed lumbar spinal stenosis with a progressive neurologic deficit that caused severe leg pain, affected bladder function, and affected gait. Relevant medical literature is reviewed. RESULTS: Bladder function and gait returned after spinal surgery, and this patient's pain was greatly reduced. A multidisciplinary team applied therapy after surgery. The medical literature do

[Computer-assisted surgery: automated screw placement in the vertebral pedicle].

AIM OF THE STUDY: Previous studies of conventional surgical procedures have shown a significant rate of incorrect pedicle screw placement ranging from 10 to 40%. Transpedicle screw insertion may cause three types of complications: neurologic, vascular and mechanical. The aim of this prospective study is to improve the reliability of pedicle screwing with computer assistance. MATERIAL AND METHODS: A new and original technique that combines preoperative computed tomography imaging with intraoperative passive navigation has been used to perform 48 pedicle screwings in the thoracolumbar region. I

Posterior fusion of the lumbosacral spine. Evaluation of the operative results and the factors influencing them.

The operative results of 79 patients subjected to posterior fusion of the lumbosacral spine were evaluated on the basis of a follow-up examination performed on average 5.4 years after operation. A method of evaluation was developed which measured the patients' subjective improvement and working capacity. The method proved appropriate for clinical use and gave a more correct picture of the operative result than methods relying on the patients' own opinion or the radiographic assessment as the only criterion. Sixty per cent of the patients were subjectively improved, 40 per cent had returned to

Analysis of Cost and 30-Day Outcomes in Single-Level Transforaminal Lumbar Interbody Fusion and Less Invasive, Stand-Alone Lateral Transpsoas Interbody Fusion.

BACKGROUND: A comparative evaluation of operative costs between single-level transforaminal interbody fusion (TLIF) and stand-alone lateral transpsoas interbody fusion (LIF) has not yet been done. We analyzed the costs, operative parameters, and early outcomes of single-level stand-alone LIF versus single-level TLIF. METHODS: Ten patients who underwent single-level TLIF and 10 patients who underwent single-level stand-alone LIF were included in the analysis. Total, variable, and fixed costs from perioperative data were available from a single institution. In addition, patient demographics, le

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related re-operation rate. Groups W and C enrolled initially each 2

Traumatic lumbosacral dislocation: four cases and review of literature.

Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. Evidence of lumbosacral dislocation should be examined and confirmed by computed tomography scans in patients with multiple fractures of transverse lumbar processes, asymmetric lumbosacral joints on frontal images, or slipping of L5 over S1 on lateral images. Treatment consists of reduction of the dislocated

[Spinal growth under physiological and pathological conditions].

Spinal growth is developing analogously to extremity growth. As the vertebral spine is built by 25 "vertebral units" there are much more possibilities of compensatory growth in short parts of pathologic alterations than there are in cases of affected extremities that only show epiphyseal compensations in metaphyseal or diaphyseal deformities (such as juvenile fractures). The dynamics of growth is different in the spine. The neurocentral epiphysis, basis to seize of spinal channel, shows very strong dynamics in embryonal and early childhood growth corresponding to the development in central ner

Oral Presentations

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… The aim of this study was to compare clinical, radiographic outcomes, and complications following LE-ULBD and MIS-TLIF for degenerative spondylolisthesis. … Conclusion: For stable, degenerative spondylolisthesis, LE-ULBD is an effective minimally invasive surgical treatment with comparable efficacy, safety, and patient satisfaction to MIS-TLIF. …

Association between vertebral endplate defects and patient-reported symptoms: an immunohistochemical study investigating the COX-2/PGE-2/EP-4 axis.

BACKGROUND CONTEXT: Vertebral endplate defects are often implicated in degenerative disc disorders, yet their connection to patient-reported … lumbar disc herniation accompanied by degenerative lumbar spinal stenosis, and 34 with degenerative spondylolisthesis. OUTCOME MEASURES: Demographic data, Pfirrmann grade, Modic changes, endplate defect score, visual analog scale (VAS) for back and leg pain, and Oswestry Disability Index (ODI) before surgery, 3-month and 6-month follow-up, and the percentage of im …

The Effect of Preoperative Symptom Duration on Postoperative Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: Retrospective. OBJECT: This study aims to examine whether the time spanning from symptom onset to surgical intervention has an effect on postoperative clinical improvement in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA: Evidence is limited regarding the influence of preoperative symptom duration on patient-reported outcomes (PROs). METHODS: Patients undergoing a primary, single-level minimally invasive transforaminal lumbar interbody fusion were retrospectively reviewed and stratified according to preoper

Surgical outcomes for painless drop foot due to degenerative lumbar disorders.

STUDY DESIGN: Twenty patients presenting with painless drop foot who had undergone lumbar spine surgery for degenerative lumbar diseases were included in this retrospective study. OBJECTIVE: This study aims to investigate which causative factors and patient symptoms significantly affected surgical outcome. SUMMARY OF BACKGROUND DATA: Drop foot is a neuromuscular condition that results in dorsiflexion palsy of the ankle. Patients with drop foot often complain of leg pain. Rarely, patients experience painless drop foot due to lumbar degenerative disease. For these patients, the only purpose of

Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up.

OBJECT: Axial lumbar interbody fusion (AxiaLIF) is a minimally invasive presacral surgical technique that damages neither the anulus fibrosus nor the anterior or posterior longitudinal ligaments. The technique was initially designed and used for L5-S1 interbody fusions and recently was extended to 2-level fusions (L4-5 and L5-S1). Until now, only biomechanical and radiological studies have discussed the feasibility of this new indication, and no clinical study has been published. The purpose of this article is to report results and complications associated with 2-level presacral AxiaLIF with a

Back pain in the young athlete.

Back pain in the young athlete is a common finding. There are many different problems that can cause back pain in active children. It is important for the treating physician to obtain a thorough history and physical examination to help in establishing the underlying cause for the discomfort. Appropriate imaging can be determined by these findings and further help to define the pathology. Depending upon the specific pathology, appropriate treatment may help the patient to safely return to the activities that they enjoy.

Clinical and radiographic outcomes of robotic-assisted direct pars repairs for spondylolysis.

BACKGROUND: Spondylolysis is one of the most common identifiable causes of low back pain in young athletes. Direct pars repair offers a moti … mean 16 years, range 10-23) with 63 pars fractures (92% bilateral). Four patients (12%) had Grade 1 spondylolisthesis. Mean spondylolysis gap size was 1.5 mm (range 0.0-7.7 mm). Mean bilateral repair operative time was 118 min, and 27 patients (84%) were discharged same-day. Fourteen fractures had bone grafting at index surgery, and three patients (STIR negative) u …

Outpatient outcomes of patients with femoral nerve neurapraxia after prone lateral lumbar interbody fusion at L4-5.

OBJECTIVE: Single-position prone lateral lumbar interbody fusion (LLIF) improves the efficiency of staged minimally invasive lumbar spine su … t single-position prone LLIF at L4-5 and percutaneous pedicle screw fixation for lumbar stenosis or spondylolisthesis were included if they had at least 6 weeks of follow-up. Outpatient postoperative neurological symptoms were analyzed at 6-week, 3-month, and 6-month follow-up evaluations. RESULTS: Twenty-nine patients (16 women [55%]; overall mean ± SD age 62 ± 1 …

Psoas weakness following oblique lateral interbody fusion surgery: a prospective observational study with an isokinetic dynamometer.

BACKGROUND CONTEXT: Although the surgical corridor used for oblique lateral interbody fusion (OLIF) protects the intrapsoas nerves by causing minimal compression, transient weakness remains the most commonly reported postoperative complication. PURPOSE: Using a dynamometer to evaluate how the hip flexor strength changes following OLIF. STUDY DESIGN/SETTING: A prospective observational study. PATIENT SAMPLE: Forty-six patients who underwent single or multi-level OLIF for lumbar spondylolisthesis. OUTCOME MEASURES: Isokinetic dynamometer values (peak torque, total work, average power), visua…