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At least 199 records · Page 11Linked to original sources
PubMed1996

Effect of intrathecal opioids on somatosensory-evoked potentials during spinal fusion in children.

STUDY DESIGN: Intraoperative recording of somatosensory-evoked potentials is useful for monitoring spinal cord tolerance during spinal fusion with instrumentation. Volatile anesthetic agents are known to have prominent suppressive effects on somatosensory-evoked potentials. This study evaluates the effect of intrathecal administration of opioid, consisting of morphine sulfate and sufentanil, on somatosensory-evoked potential monitoring. OBJECTIVES: To study the effect of different anesthesia techniques on somatosensory-evoked potentials during spinal fusion. SUMMARY OF BACKGROUND DATA: The effect of intravenous narcotic administration on somatosensory-evoked potentials has been well studied and reported. This study shows the effect of intrathecal opioids on somatosensory-evoked potentials. METHODS: Ten patients scheduled for spinal fusion with Cotrel-Dubousset instrumentation were induced with thiopental and maintained with intrathecal morphine sulfate (20 micrograms/kg) and sufentanil 50 micrograms, supplemented with isoflurane 0.5% air and oxygen. Routine monitoring was done, including arterial line and continuous somatosensory-evoked potentials. Anesthesia was maintained constant, with a mean blood pressure of 55 mm Hg. Normocarbia and normothermia were maintained. Baseline somatosensory-evoked potentials were recorded using bilateral posterior tibial nerve stimulation, with constant somatosensory-evoked potential monitoring after the induction of anesthesia. RESULTS: There were no significant changes in either latencies or amplitudes in cortical somatosensory-evoked potentials after opioid injection at any time during the surgical procedures. CONCLUSIONS: Somatosensory-evoked potential monitoring was possible in all patients undergoing extensive spinal surgery. Intrathecal opioid anesthesia with low concentrations of isoflurane in air and oxygen seems to have no effects on somatosensory-evoked potentials.

Adolescent↗
PubMedDate not supplied

In vivo evaluation of calcium sulfate as a bone graft substitute for lumbar spinal fusion.

BACKGROUND CONTEXT: Posterolateral fusions of the lumbar spine have nonunion rates as high as 35%. The availability of autologous bone to promote fusion is limited, particularly for multilevel fusions. Bone substitutes have been proposed to augment or replace autologous bone for spinal surgery. Calcium sulfate offers high porosity, osteoconductivity, and high resorption rate. This material has been used successfully for treatment of long bone defects but has not been investigated as a bone graft substitute for spinal fusions. PURPOSE: To determine whether the use of calcium sulfate granules in conjunction with an implantable electrical stimulator is a safe and effective means of attaining spinal fusion. STUDY DESIGN/SETTING: A rabbit lumbar fusion model was used to assess a calcium sulfate bone graft substitute in combination with electrical stimulation for spinal fusion. METHODS: Thirty-six adult New Zealand White female rabbits were divided into three groups. Each group underwent a single-level (L5-L6) fusion, receiving 3.0 cc calcium sulfate granules with bone marrow aspirate from the iliac crest. Group 1 had no electrical stimulator applied. Groups 2 and 3 received a 40-microA (Group 2) or a 100-microA (Group 3) implantable electrical stimulator. The animals were sacrificed at 8 weeks, and the rabbit spines were subjected to radiographic assessment, manual palpation, and mechanical testing. RESULTS: Two rabbits died postoperatively. The radiographic assessment revealed no fusions occurred at the adjacent nonoperated control levels (L4-L5). There were no fusions observed within Group 1, containing the calcium sulfate and bone marrow aspirate alone. The sites with the implantable stimulators showed a dose-dependent increase in fusion stiffness. However, no fusion mass in Group 2 or 3 was graded as bilaterally complete. CONCLUSION: This study found that calcium sulfate as a bone graft substitute was unsuccessful in promoting spine fusion in a rabbit model. There was radiographic evidence of rapid resorption of the calcium sulfate within 4 weeks after surgery. The use of electrical stimulation created a dose-dependent increase in mechanical competence of the bony mass. However, the addition of direct current (DC) current did not significantly alter fusion rates with calcium sulfate used as the bone graft substitute in this model.

Animals↗
PubMed1997

Theoretical evaluation of peripheral nerve stimulation during MRI with an implanted spinal fusion stimulator.

This study examines the requirements for nerve excitation near a spinal fusion implant during magnetic resonance imaging. The implant is the Spinal Fusion SpF device manufactured by Electro Biology Inc. The electric field induced within the biological medium was calculated using a three-dimensional finite difference model (described in a separate paper by Beuchler et al. from the University of Utah). Magnetic thresholds were obtained for excitation of myelinated nerve fibers that are near the implant. Minimum (rheobase) thresholds were determined for long duration dB/dt pulses, as well as strength-duration time constants (from which thresholds at other durations could be determined) for various geometries between the implant and a myelinated nerve fiber. The lowest thresholds occur when a large (20-microm diameter) fiber is situated near the bare tip of a wire from the implant, and a long duration (2 ms) stimulus is provided for which dB/dt is constant and monophasic. Magnetic thresholds for shorter durations of dB/dt are higher in accordance with a strength-duration law. In a magnetic field having a time derivative of 10 T/s that is uniform over the torso, nerve excitation is possible under worst-case conditions only for nerve fibers that are within 0.14 mm of the bare wire tip of the implant. With 20 T/s, excitation is possible only within 1 mm of the wire tip.

Animals↗
PubMed1997

Vascularized fibula graft for spinal fusion in severe cervical kyphosis due to neurofibromatosis.

A successful anterior spinal fusion using vascularized fibula graft in the case of a 17-year-old male with severe cervical kyphosis due to neurofibromatosis is reported. Anterior spinal fusion at C2-7 using the fibula graft was performed with spinous process wiring. The kyphosis was corrected from 85 to 38 degrees. Bony fusion was obtained in 5 months without loss of correction.

Adolescent↗
PubMed1977

Syphilitic aortic aneurysm with spinal erosion. Treatment by aneurysm replacement and anterior spinal fusion.

Five cases of syphilitic aortic aneurysm with erosion of the spinal column are reviewed. Four patients underwent operation. When erosion of the spine was mild or moderate, the aortic lesion only was treated. Aneurysm associated with extensive vertebral erosion was treated in two cases by anterior spinal fusion combined with replacement of the disc and part of the aorta. In one of these cases the spine was later reinforced by a posterior spinal fusion. One patient so treated died a week after operation. The patient who refused operation later developed a complete paraplegia.

Adult↗
PubMed1997

[The effects of spinal fusion on respiratory function and quality of life in Duchenne muscular dystrophy].

We studied the functional outcome of spinal fusion for the surgical treatment of scoliosis in 8 patients with Duchenne muscular dystrophy (DMD). The mean age of DMD patients at the time of the surgery and the mean follow-up duration was 13.8 (12.3 to 15.4) and 3.9 (1.5 to 6.8) years, respectively. The average spinal angle (Cobb angle) was corrected from 58.8 to 28.6 degrees with the mean corrective rate of 51.3% by the surgical intervention. The correction rate was higher and the corrected Cobb angle remained unchanged during follow-up period in mildly scoliotic patients. Forced vital capacity (FVC) increased post-operatively in 3 patients with moderate scoliosis (Cobb angle: 50 to 80 degrees), indicating that the correction of spinal alignment is effective for the treatment of decreased thoracic volume in DMD. On the other hand, two cases with low % FVC (16.9% and 30.4%, respectively) had poor prognosis in respiratory status. Namely, one died of pneumonia at 17 months after the surgery and the other required mechanical ventilation via nasal mask at 3 years post surgery. Sitting balance improved in all patients, which resulted in more functional use of their upper extremities. During the follow-up period, all patients except one patient who died of pneumonia could maintain sitting balance without support. Moreover these included 2 patients over 20 year old. No complications related to spinal deformities have been found in these patients. Previous study in our hospital showed that 7 of 48 (14.6%) of DMD patients spent all their lives without apparent scoliosis (Cobb angle less than 30 degrees). These suggest that spinal fusion could be recommended for patients with Cobb angle more than 30 degrees and with % FVC more than 35%. Although the impact of spinal fusion upon the life expectancy remains unclear, favorable effect on respiratory function and quality of life can be expected for carefully selected patients with DMD.

Adolescent↗
PubMed2004

The use of bone morphogenetic protein-6 gene therapy for percutaneous spinal fusion in rabbits.

OBJECT: Fusion procedures in the lumbar spine have been performed in the US since 1911. Since that time, the indications and techniques for spinal fusion have evolved. Despite technical advancements, spinal fusion remains a major operation, and fusion nonunion rates of up to 35% are still reported. In this study, the authors were able to induce intertransverse process fusions in immune-competent New Zealand White rabbits by percutaneous administration of an adenoviral vector containing the bone morphogenetic protein (BMP-6) gene (Ad-BMP-6). The results represent an important step forward in finding new methods to increase the success and decrease the morbidity associated with spinal fusion. METHODS: Five New Zealand White rabbits were used. Injection of the adenoviral construct was performed at multiple levels (bilaterally) in each animal while using fluoroscopic guidance. Injection consisted of either Ad-BMP-6 or Ad-beta-galactosidase (beta-gal) (control). Because multiple levels were injected, each animal served as an internal control. The animals underwent postinjection computerized tomography (CT) scanning at 7 and 14 weeks. After undergoing final CT scanning, the animals were killed and the spines were harvested. The fusion sites were analyzed by gross inspection, histopathological methods, and micro-CT studies. CONCLUSIONS: The results of this study show that an anatomically precise fusion can be accomplished by percutaneous administration of gene therapy. The next step in these studies will be extension of the technique to nonhuman primates and eventually to human clinical studies.

Adenoviridae↗
PubMed2005

Small bowel perforation from unit rod posterior spinal fusion.

An unusual complication of bowel perforation after unit rod posterior spinal fusion and anterior spine release via a retroperitoneal approach is described. This complication has not been previously described. The pediatric surgical specialist should be aware of this consideration in the differential diagnosis of abdominal pain after unit rod posterior spinal fusion.

Abdominal Pain↗
PubMed1995

The morbidity of heparin therapy after development of pulmonary embolus in patients undergoing thoracolumbar or lumbar spinal fusion.

STUDY DESIGN: The postoperative course of patients who developed a pulmonary embolus after thoracolumbar or lumbar spinal fusion treated with heparin was studied to quantify the morbidity risk of anticoagulation. OBJECTIVE: To compare the morbidity risk of heparinization with that of an alternative form of therapy--inferior vena cava filter placement. SUMMARY OF BACKGROUND DATA: Therapeutic heparinization was the current treatment of choice for patients who develop thromboembolic disease after surgery. Although heparin usage was reported to be associated with a number of complications after other orthopedic and general surgical procedures, no information was available to identify complications of heparinization after lumbar or thoracolumbar spine surgery or to define the risk of such complications. METHODS: Twenty-two members of the Scoliosis Research Society were polled to determine their experiences with the anticoagulation of this subset of patients. Surgeons polled had a combined experience of 250 man-years and had performed more than 13000 thoracolumbar and lumbar spinal fusions. The MEDLINE database was used to review pertinent English language publications describing inferior vena cava filter complications, effectiveness, safety, and indications for use. RESULTS: Nine patients were located who fit the inclusion criteria of this study. Six (67%) had complications attributable to heparinization. Clinically significant complications of filter placement ranged from 0.12% to 10.1%. CONCLUSIONS: Heparinization after the development of pulmonary embolus in patients recently undergoing spinal fusion is associated with a high complication rate. The morbidity of vena cava filter placement is low and should be considered a treatment alternative in the treatment of patients who experience pulmonary embolus after surgery.

Adolescent↗
PubMedDate not supplied

A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents.

BACKGROUND AND OBJECTIVES: Pain and gastrointestinal dysfunction are primary factors that delay recovery after posterior spinal fusion. Previous reports suggest that the choice of analgesic management may effect the course of recovery. This prospective, randomized study compared continuous thoracic epidural analgesia and patient-controlled analgesia in the postoperative care of adolescents undergoing posterior spinal fusion for idiopathic scoliosis. METHODS: Patients between 11 and 18 years of age were randomized to receive continuous thoracic epidural analgesia with bupivacaine-fentanyl (CEA, n = 17) or intravenous patient-controlled analgesia with morphine sulfate (n = 16). After surgery under general anesthesia, pain intensity was evaluated using a self-report visual analog scale (VAS). Postoperative time to resumption of bowel sounds, liquid intake, and side effects were also recorded. RESULTS: There were no significant differences between groups in VAS pain scores, side effects, or time to resumption of liquid intake. There was a significant difference (P = .0089) between groups in return of bowel sounds, which occurred earlier in patients receiving CEA. CONCLUSIONS: Continuous epidural analgesia and patient-controlled analgesia are comparably effective and safe after posterior spinal fusion. Return of bowel sounds occurred significantly more rapidly in patients receiving CEA postoperatively.

Adolescent↗
PubMed2004

Activation of the renin-angiotensin system contributes significantly to the pathophysiology of oliguria in patients undergoing posterior spinal fusion.

BACKGROUND AND OBJECTIVE: This study was undertaken to investigate the role played by antidiuretic hormone (ADH), the renin-angiotensin system and atrial natriuretic factor (ANF) in the oliguria in patients undergoing spinal fusion. METHODS: Sixteen patients undergoing posterior spinal fusion using isoflurane and fentanyl (n = 8) or sufentanil (n = 8) had renin, aldosterone, ADH and ANF measurements. RESULTS: Compared to the non-oliguric patients, the oliguric patients had a higher number of fused vertebrae 10.5 +/- 1.3 vs. 9.0 +/- 0.5 (P = 0.01) and higher renin values at 12h (3.3 +/- 3.2 vs. 0.7 +/- 0.6 ng L(-1) s(-1), P = 0.04). Hormonal values that had a significant correlation with intraoperative diuresis were: renin at 0.5 h (r2 = 0.26, P = 0.04), aldosterone at 0.5 h (r2 = 0.30, P = 0.03) and ANF at 0.5 h (r2 = 0.32, P = 0.02). Those that had a significant correlation with the mean postoperative diuresis were: renin at 6 h (r2 = 0.29, P = 0.03), 8h (r2 = 0.26, P = 0.04) and 12h (r2 = 0.31, P = 0.03), aldosterone at 6h (r2 = 0.54, P = 0.001), 8h (r2 = 0.40, P = 0.01) and 12h (r2 = 0.32, P = 0.03), ADH at 24h (r2 = 0.38, P = 0.01) and ANF at 6h (r2 = 0.26, P = 0.045). Using stepwise regression, excluding hormonal values, only two continuous variables had a significant correlation with the mean postoperative diuresis: the number of fused vertebrae (P = 0.02) and the length of surgery (P = 0.02). CONCLUSION: Activation of the renin-angiotensin system is the major cause of the early intraoperative oliguria. ADH and the renin-angiotensin system are both involved in the pathophysiology of postoperative oliguria in patients undergoing spinal fusion.

Adolescent↗
PubMedDate not supplied

Comparison of one-stage versus two-stage anterior/posterior spinal fusion for neuromuscular scoliosis.

Twenty-six patients with progressive neuromuscular scoliosis underwent anterior/posterior (AP) spinal fusion. Thirteen of the patients underwent a one-stage fusion, and 13 underwent a two-stage fusion. Although one-stage AP spinal fusion provides adequate correction of severe curves and allows a more expeditious recovery without increasing patient morbidity or mortality, current third-party payor reimbursement policies provide little incentive for 1-day operations. In addition, the procedure is mentally and physically demanding and the apparent benefits must be weighed against the potential harm that can result from surgeon fatigue or lack of appropriate planning.

Adolescent↗
PubMed1994

Prognostic factors in lumbar spinal fusion.

The charts of 234 patients who underwent 260 spinal fusions for degenerative spinal disease were reviewed to determine prognostic factors for predicting successful surgical outcome. All patients were evaluated for fusion success and symptomatic relief. Pseudarthrosis occurred in 26 patients (10%) and 14 others failed to have symptomatic improvement despite successful fusion. Outcome was found to be significantly related to smoking status, diagnosis, use of hardware, insurance status, preoperative SGPT level, prior operations or decompressions, and age. The relative risk associated with smoking was 2.9. The association with smoking was present for both subjective and objective poor outcomes. A predictive function based on smoking status and diagnosis was developed. Ninety-two percent of nonsmokers with favorable diagnoses had a good outcome, compared to 77% of those with unfavorable diagnoses. The percentages for the comparable groups of smokers were 77% and 54%.

Adolescent↗
PubMed1989

Experimental allograft in spinal fusion in dogs.

Fifty-six dogs were used for the comparison of the allogenous and autogenous bone graft in anterior interbody and posterior spinal fusion. Excluding 7 cases with wound infections, the end results of the allograft and autograft in anterior interbody and posterior spinal fusion were nearly the same, provided that the rules of technique for the spinal fusion were strictly followed, especially in the allograft group. Grossly, there was a reduction tendency in the fusion mass of the allograft group that was proven by roentgenographic examination of the harvested spinal block. Histologically, there was no evidence of regeneration of the allograft that can be readily detected in the autograft. In the allograft group, osteogenesis can only be seen in the recipient sites, the allograft transplants become sequestrated and resorbed.

Animals↗
PubMed2005

The effect of cyclooxygenase-2 inhibition on analgesia and spinal fusion.

BACKGROUND: Cyclooxygenase (COX)-2-specific inhibitors demonstrate analgesic efficacy comparable with that of conventional nonsteroidal anti-inflammatory drugs but are associated with reduced gastrointestinal side effects and an absence of antiplatelet activity. Thus, they can be administered to patients undergoing spinal fusion surgery without an added risk of bleeding. However, concerns regarding a possible deleterious effect on bone-healing have limited their routine use. Celecoxib, a COX-2 inhibitor, recently was approved for the treatment of acute pain. The goals of the present study were to examine the analgesic efficacy of celecoxib and to determine the incidence of nonunion at one year following spinal fusion surgery. METHODS: Eighty patients who were scheduled to undergo spinal fusion received either celecoxib or placebo one hour before the induction of anesthesia and every twelve hours after surgery for the first five postoperative days. Pain scores and morphine use were recorded one hour after arrival in the post-anesthesia care unit and at four, eight, twelve, sixteen, twenty, and twenty-four hours later. Intraoperative blood loss was recorded. The status of the fusion was determined radiographically at the time of the one-year follow-up. RESULTS: There were no differences in demographic data or blood loss between the two groups. Pain scores were lower in the celecoxib group at one, four, eight, sixteen, and twenty hours postoperatively. There were no differences between the two groups with regard to the pain scores at twelve and twenty-four hours postoperatively. Morphine use was lower in the celecoxib group at all postoperative time-intervals. There was no difference between the celecoxib group and the placebo group with regard to the incidence of nonunion at the time of the one-year follow-up (7.5% [three of forty] compared with 10% [four of forty]). CONCLUSIONS: The perioperative administration of celecoxib resulted in a significant reduction in postoperative pain and opioid use following spinal fusion surgery. In addition, the short-term administration of this COX-2-specific non-steroidal anti-inflammatory drug had no apparent effect on the rate of nonunion at the time of the one-year follow-up.

Adult↗
PubMed2003

Treatment of neuromuscular scoliosis with posterior spinal fusion using the Galveston technique: a retrospective review and results of 62 patients.

Historically, the operative treatment of neuromuscular scoliosis has been associated with a high rate of complication. Recent literature has shown a decreased rate of complication (less 50%) in the management of neuromuscular scoliosis with spinal arthrodesis techniques. A retrospective chart and radiographic review of 62 spinal fusions for neuromuscular scoliosis was performed. There were 53 posterior spinal fusions and 9 anteroposterior spinal fusions. The Galveston technique was used in all patients. The average age at surgery was 13 years 7 months, with an average follow-up of 23 months (minimum 10 months). The mean preoperative and postoperative curve magnitudes were 66 degree and 31 degree, respectively. There were 20 minor complications and 5 major complications in 20 patients. There were no neurologic complications or deaths.

Adolescent↗
PubMed2005

[Indication and surgical methods of lumbosacral spinal fusion for lumbal degenerative diseases].

In degenerative lumbar spinal diseases with low back pain and leg pain, the indications for lumbar spinal fusion are not clear. It is unclear for the following reasons. The definition of instability is not clear. And it is also difficult to observe the exact source of the low back pain. In addition, there are limited numbers of randomized prospective study about the usefulness of spine fusion. Controversy still exists for when spinal instrumentation should be used. A spinal surgeon performs a posterolateral fusion or a posterior interbody fusion with or without instrumentation, mainly based on his experience and belief.

Humans↗
PubMed1997

In vivo evaluation of a resorbable osteoinductive composite as a graft substitute for lumbar spinal fusion.

The purpose of this prospective animal study was to evaluate the efficacy of a resorbable coral particulate to serve as a carrier with several doses of a bovine-derived osteoinductive bone protein mixture. A previously validated rabbit model for posterolateral intertransverse process lumbar spinal fusion was used. Posterolateral intertransverse process arthrodeses were performed at L5-L6 in 64 adult New Zealand white rabbits. The bone graft substitute evaluated consisted of a Biocoral/collagen composite with one of four doses (0, 100, 300, or 1,000 micrograms) of a bovine-derived osteoinductive bone protein extract (BP). Fusions were assessed at 5 weeks by manual palpation, radiography, histology, and biomechanical testing. Use of the Biocoral/collagen carrier without BP resulted in no solid fusions. Biocoral/collagen with 100 micrograms BP resulted in solid fusions in 31% (4 of 13) of the rabbits. Biocoral with 300 micrograms or 1,000 micrograms BP resulted in solid spinal fusion in all rabbits (27 of 27). There were no neurologic complications related to the growth factor or carrier. Small subcutaneous collections of serous fluids were noted in 26% of the animals in the 1st postoperative week, but resolved without problems by the 5th week. Such seromas may limit the clinical utility of this growth factor-carrier combination. Biocoral/collagen combined with the appropriate dose of bovine-derived osteoinductive bone protein was efficacious as a bone graft substitute for achieving posterolateral lumbar spinal fusion in the rabbit model. A dose of 300 micrograms BP was determined as the threshold to reliability produce solid spinal fusions.

Absorption↗