Abstract:

OBJECTIVE: This case series assesses the pre- and postoperative disability outcomes and complications after repeat micro lumbar discectomy (MLD) combined with an interspinous process fusion in patients with recurrent lumbar disc herniation.
METHODS: Four consecutive patients with recurrent lumbar disc herniation subsequent to their primary discectomy, who failed conservative nonoperative management, underwent repeat MLD and posterior instrumented fusion with an interspinous process plate. Before surgery and at follow-up, patients completed the Oswestry Disability Index (ODI). Demographic information, length of stay, estimated blood loss, and intraoperative and postoperative complications were recorded.
RESULTS: The mean patient age was 45 years. Patients experienced minimal blood loss during surgery. There were no intraoperative or postoperative complications. Mean operating time was 136 minutes. Mean hospital stay was 1 day. Mean ODI score was reduced from 83.5 preoperatively to 37.0 postoperatively at a mean follow-up time of 12.9 months. As of last follow-up (mean 387 days), no patient has had symptomatic recurrence of herniation or evidence of subsequent instability.

Authors:

Jeffery S. Oppenheim, MD, Instructor in Neurosurgery, Columbia University College of Physicians and Surgeons, Chief, Section of Neurosurgery, Good Samaritan Hospital, Suffern, NY, Surgeon, Hudson Valley Brain and Spine Surgery, Suffern, New York, James Mills, MS, RPA-C, Physician Assistant, Hudson Valley Brain and Spine Surgery, Suffern, New York

PMID: 23686800

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Abstract:

Amicar may affect estimated blood loss (EBL) and blood transfusion in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with pedicle screws and Ponte osteotomies. We performed a retrospective analysis of a prospectively collected, single-center database of 33 patients with main thoracic AIS treated with greater than 80% pedicle screws. Patients were divided into two groups based on whether they received Amicar (Yes), or did not receive any antifibrinolytics and Ponte osteotomies (No). Demographic, radiographic, and intraoperative data were compared between the two groups. Seventeen patients were treated with Amicar (Yes) (10 of whom had Ponte osteotomies) and 16 patients had neither antifibrinolytics nor Ponte osteotomies (No). The two groups had similar preoperative main Cobb angles, major curve flexibility, and gender. Despite longer operating times and a majority of patients receiving Ponte osteotomies, the Amicar group had a significantly lower EBL and homologous blood transfusion rate. Autologous transfusion volume was less in the Amicar group and trended toward significance. There were no differences in mean arterial pressure during surgery. There were no complications in either group. Amicar reduces EBL and homologous transfusion requirements in patients with main thoracic AIS undergoing PSF with pedicle screws and Ponte osteotomies.

Authors:

Justin Iorio, MD, Orthopaedic Surgery Resident, Temple University School of Medicine , Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, Pennsylvania, James T. Bennett, MD, Research Fellow, Shriners Hospitals for Children, Philadelphia, Pennsylvania, Giuseppe Orlando, MD , Orthopaedic Surgery Resident, School of Orthopaedics and Traumatology , SOM University of Messina, Messina, Italy, Anuj Singla, MD, Pediatric Spinal Deformity Fellow, Shriners Hospitals for Children, Philadelphia, Pennsylvania, Elias Dakwar, MD, Pediatric Spinal Deformity Fellow, Shriners Hospitals for Children, Philadelphia, Pennsylvania, Harry Bonet, MD, Chief of Anesthesia, Shriners Hospitals for Children, Philadelphia, Pennsylvania, Amer F. Samdani, Chief of Surgery, Shriners Hospitals for Children, Philadelphia, Pennsylvania

PMID: 23975447

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Abstract:

Lumbar spinal fusion is a well-established surgical procedure for many spinal conditions. Posterior instrumentation may be added to provide immediate stabilization and improve fusion rates. Spinous process fixation, a type of posterior fixation, offers a less-invasive option to pedicle or facet screws with quantitative evidence of similar biomechanical stabilization; however, little has been published on the use of these devices. Further, there has been confusion about the use of spinous process fixation devices versus spinous process spacers. Spinous process fixation devices provide spine surgeons with another option for instrumented fusion, offering potential advantages for select patients. Biomechanical data suggest that relative to pedicle screws, modern spinous process fixation devices provide equivalent stability with reduced clinical risk and a less-invasive surgical procedure. These devices need to be distinguished from spacers, which are non-fixation devices.

Authors:

Mitchell Hardenbrook, MD, Assistant Clinical Professor, Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, Jeffrey S. Henn, MD, Neurosurgeon , Lee Memorial Hospital, Fort Myers, Florida, Jeffrey Oppenheim, MD, Instructor in Neurosurgery, Columbia University College of Physicians and Surgeons , Chief, Section of Neurosurgery, Good Samaritan Hospital, Suffern, New York, Mitesh V. Shah, MD, Associate Professor of Surgery, Section of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana

PMID: 24081843

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Abstract:

Spinous process fixation (SPF) is presented as less invasive than pedicle screws. There has been little quantitative data to support this assertion, and “minimally invasive” has not been well defined in spine surgery. Length of stay (LOS) and blood loss (BL) were chosen as surrogate measures of “minimally invasive.” A chart review was conducted on 192 lumbar fusion patients (374 levels). A backward-selection multiple-linearregression was performed to determine what variables contribute to LOS and estimated blood loss (EBL). A logistic regression controlling for age and number of levels on complication rates was also performed. Number of levels with supplementary screw fixation (SSF) was significantly associated with LOS (p = 0.003). Controlling for number of surgical levels, LOS increased by 0.30 days (95% CI: 0.02–0.58) for each level with SSF. For each additional level including SSF, BL increases by 25.31 cc (95% CI: 3.50–47.12, p = 0.023). Interbody fusion increases blood loss by 68.16 cc (95% CI: 17.18–119.13, p = .009). For each additional level with SSF, odds of perioperative complications increase by OR = 2.34 (95% CI: 1.35–4.05). Long-term complications were not affected by instrumentation. LOS and BL are increased in patients with SSF vs. SPF only. Odds of perioperative complications are increased in patients with SSF relative to those treated with SPF alone.

Authors:

Ranjith Babu, MS, Research Assistant, Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, Oren N. Gottfried, MD, Assistant Professor of Surgery, Department Of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina , John C. Stevenson, MD, FRCS, Neurosurgeon, The Orthopedic Institute, Gainesville, Florida

PMID: 24081846

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Abstract:

Intraoperative motor evoked potentials (MEP) and electromyography (EMG) monitoring in patients with spinal and cranial lesions is a valuable tool for prevention of postoperative motor deficits. The purpose of this study was to determine whether electrophysiological monitoring during skull base, spinal cord, and spinal surgery might be useful for predicting postoperative motor deterioration. From January 2012 to March 2013, thirty-three consecutive patients were studied using intraoperative monitoring (Nuvasive NV-M5 System) to check the integrity of brainstem, spinal cord, and nerve roots, recording transcranial motor evoked potentials (TcMEPs) and electromyography. Changes in MEPs and EMGs were related to postoperative deficits. Preoperative diagnosis included skull base and brainstem lesions (6 patients), spinal tumors (11 patients), spinal deformity (16 cases). Using TcMEPs and EMG is a practicable and safe method. MEPs are useful in any surgery in which the brainstem and spinal cord are at risk. EMG stimulation helps to identify an optimal trans-psoas entry point for an extreme lateral lumbar interbody fusion (XLIF) approach to protect against potential nerve injury. This neural navigation technique via a surgeon-interpreted interface assists the surgical team in safely removing lesions and accessing the intervertebral disc space for minimally invasive spinal procedures.

Authors:

Roberto Gazzeri MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Andrea Faiola MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Massimiliano Neroni MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Claudio Fiore MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Giorgio Callovini MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy, Mauro Pischedda MD, Department of Neuroanesthesia, San Giovanni Addolorata Hospital, Rome, Italy, Marcelo Galarza MD , Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia - Spain

PMID: 24085510

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