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PubMed1982

The evaluation of Kiel bone in spinal fusions.

The clinical, radiological and histological information on the fate of Kiel bone implants for anterior spinal fusion in four patients was evaluated. These implants were found to be unsatisfactory and further operations were required. Biopsies of the grafts showed that the Kiel bone was invaded by fibrous tissue but that it did not ossify or become incorporated into the underlying bone. However, it might provide temporary support to the grafted area. These findings indicate that the use of Kiel grafts does not seem to be justified in current orthopaedic practice.

Adult↗
PubMedDate not supplied

Anterior spinal fusion complicated by paraplegia. A case report of a false-negative somatosensory-evoked potential.

A case of an anterior spinal artery syndrome complicating an anterior spinal fusion is reported. Besides documenting a relatively rare complication of anterior spinal surgery, the level of the lesion (T6) and the association of spinal shock are relatively unusual. Intraoperative somatosensory-evoked potentials (SEP) deteriorated only transiently and failed to reflect adequately the neurologic injury either intraoperatively or postoperatively. The shortcomings of SEP monitoring are discussed, and the recommendation is made to use the combination of SEPs with the wake-up test when possible.

Evoked Potentials, Somatosensory↗
PubMed1994

A comprehensive study of physical parameters, biomechanical properties, and statistical correlations of iliac crest bone wedges used in spinal fusion surgery. I. Physical parameters and their correlations.

Iliac crest bone wedges are commonly used in spinal fusion procedures and must be capable of withstanding considerable mechanical stress during the healing process. The variability of "quality" of bone materials used in the production of bone wedges suggests that some bone materials may not be suitable for use in vertebral fusion procedures and some quantifiable means of predicting the suitability of bone wedges would be desirable. A total of 250 iliac crest wedges were used in this study. Physical parameters of iliac crest wedges, such as total cross-sectional area, cancellous cross-sectional area, cortical cross-sectional area, percentage of cortical cross-sectional area, "width," and apparent density were determined. The statistical correlations among physical parameters were investigated. These correlations revealed that the relative percentage of cortical and cancellous bone remained fairly constant at 41% and 59%, respectively, regardless of total cross-sectional area of a wedge, that apparent density did not appreciably change with donor age, and that ash (inorganic) and organic content (weight) correlated well with the apparent density.

Aging↗
PubMed1978

Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion.

A comparative study of 259 patients operated on for ruptured lumbar discs, with and without spinal fusion, has been carried out. Simple removal of the herniated nucleus pulposus was performed in 119 patients while 68 were subjected to combined removal of the herniated disc material and lumbo-sacral fusion. During the first postoperative months the results were similar in the two groups, with a satisfactory result in 89 and 88 per cent of the cases respectively. During the following years a significant difference occurred between the groups. Severe pain recurred in 27% of the patients with simple removal of the herniated disc material and in 15% of those with the combined operation (P less than 0.01). The cause of the recurrence in the patients without fusion was disc herniation in 10% (at the same level in 7% and at a different level in 3%), and adhesions, or osteochondrosis with or without instability in 17%. In the patients with the combined operation the recurrences were caused by pseudoarthrosis in 9%, by disc herniation in 3%, and by other causes in 3%. At the final examination 6--7 years after the first operation, the results were still better in the fused patients, but the difference was no longer significant. Eighty-five per cent of the patients with the combined operation has a satisfactory result with regard to pain as compared with 76% in the other group. Thus, the results show that the combined operation gives better protection against recurrence of pain. However, it is a more extensive procedure and has complications of its own, and it should therefore mainly be used in young patients.

Adult↗
PubMed1992

Spinal fusion in Duchenne muscular dystrophy: a multidisciplinary approach.

We studied 27 Duchenne muscular dystrophy patients having spinal fusion for scoliosis. One patient died intraoperatively of cardiac arrest; all others have done well with no instances of malignant hyperthermia, postoperative ventilatory system dependence, pneumothorax, persisting infection, neurologic damage, nonunion, or pain. The anesthetic management included primarily intravenous general anesthetics with minimal myocardial depressant effects, avoiding succinylcholine and inhalation agents. Preoperative cardiac studies aided anesthetic management intra-operatively. There was an almost universal sinus tachycardia. Holter monitoring defined 4 of 16 with ventricular premature beats, 4 of 16 with atrial premature beats, and no ventricular tachycardia or atrial flutter or fibrillation. Echocardiogram demonstrated mitral prolapse in 2 of 22, frequent abnormal systolic performance with abnormal shortening fraction less than 28% in 7 of 16, and reduced rate-corrected velocity of fiber shortening in 9 of 15. Afterload was elevated in 7 of 15. The mean forced vital capacity (FVC) preoperatively was 45.3 +/- 15.9% with continuing diminution to 28.7 +/- 14.9% at 3.3 +/- 2.2 years after surgery. The main benefit of surgical stabilization is the relative ease and comfort of wheelchair seating compared with those nonoperated patients who develop progressive deformity. We have not seen lasting improvement or stabilization in FVC following surgery as decreasing function is related primarily to muscle weakness.

Adolescent↗
PubMed1998

Fatal pulmonary fat embolism after dorsal spinal fusion.

Fatal pulmonary fat embolism is a rare complication in elective orthopaedic surgery. It has been described previously as occuring during intramedullary manipulations and in trauma patients. We present the case of a 56-year-old slender housewife with severe radicular complaints because of lumbar spinal stenosis. She underwent a dorsal bilateral decompression of L4/L5 and L5/S1 in combination with an instrumented dorsolateral spinal fusion. Transpedicular fixation of L4/L5/S1 was accomplished by titanium Rodegerdts implants. Both iliac crests were used for harvesting autologous bone grafts. The intra-operative course was uneventful; however, 6 h after surgery, despite resuscitation, she expired. Autopsy revealed macroscopic gross fatty infiltration of lung parenchyma with oedema. We believe there is no relation between this complication and the transpedicular instrumentation. The position of the patient and the extent of the harvesting technique could be critical in preventing this serious complication.

Embolism, Fat↗
PubMed2004

Low back pain after spinal fusion and Harrington instrumentation for idiopathic scoliosis.

We reviewed 41 patients with adolescent idiopathic scoliosis treated with spinal fusion and Harrington instrumentation between 1973 and 1992. The mean follow-up was 23 (11-30) years. All patients completed self-administered questionnaires, Oswestry Low Back Pain Disability Score (ODS), Roland Morris score (RLS), and Visual Analog Pain Intensity Scale (VAS). We found a high degree of satisfaction with more than three quarters of the patients in work. The outcome of ODS, RLS, and VAS showed low scores. We found a significant correlation between the scores and the Cobb angle preoperatively as well as at follow-up. The patient-oriented outcome did not correlate with the type of curve, extension of vertebral fusion, tilt angle of the lowest instrumented vertebra, postoperative Cobb angle, loss of correction, or lumbar lordosis. This long-term follow-up of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life.

Adolescent↗
PubMed1996

Superior gluteal artery injury during iliac bone grafting for spinal fusion. A case report and literature review.

STUDY DESIGN: This article reports a complication encountered when harvesting bone graft from the posterior iliac crest during a contemplated spinal fusion. OBJECTIVES: Posterior iliac crest bone grafting is commonly performed with posterior spinal instrumentation and fusion. SUMMARY OF BACKGROUND DATA: Review of the literature reveals a few case reports of damage through the superior gluteal artery during harvesting of bone grafts; this complication is managed with direct vessel ligation. METHODS: This article reviews the pertinent anatomy of posterior iliac crest bone grafting and addresses areas of caution important in preventing this complication. RESULTS: The case report offers alternative management, that is, selective arterial embolization for hemodynamic control of the massive life-threatening bleeding that can occur with superior gluteal artery lacerations. CONCLUSIONS: Injury to the superior gluteal artery is a common complication in pelvic trauma. In this patient, therapeutic arterial embolization proved to be a useful tool in controlling hemorrhage, which prevents additional bleeding problems. Superior gluteal artery injury after elective bone graft surgery is a relatively uncommon, serious, but avoidable complication. In this patient, the use of radiographically controlled arterial embolization of the lacerated vessel proved to be a quick and effective solution to this potentially life-threatening complication.

Adult↗
PubMed1993

Bilateral pedicular stress fractures after successful posterior spinal fusion for adult idiopathic scoliosis.

A patient with adult idiopathic scoliosis who was successfully treated with posterior spinal fusion with segmental instrumentation from T3 to L4 is presented. One year after surgery fractures of both L4 pedicles developed, which were managed nonoperatively. Clinical union was achieved in 2 months and the patient was followed with serial computed tomographic scans to confirm union. A review of the current literature is also presented.

Adult↗
PubMed2002

Efficacy of the anesthetic protection in one-stage anterior and posterior spinal fusion in surgery of scoliosis.

Contemporary one-stage surgery of scoliosis including consecutive anterior and posterior spinal fusion is a highly traumatic procedure that requires effective anesthetic protection of the patient during operation and in the postoperative period. It has been established that anesthetic protection with alpha-1-adrenoblockers and alpha-2-adrenoantagonists of clofelin allows minimization of the postaggressive catabolic reactions of the organism, preventing severe impairment of homeostasis, reducing considerably the rate of intra- and postoperative complications and thus ensuring the favorable outcome of the operation. The proposed method of anesthetic protection by using propofol could be a method of choice when intraoperative awakening of the patient is needed to control for possible neurological deficit.

Adolescent↗
PubMedDate not supplied

Complications after posterior spinal fusion in Duchenne's muscular dystrophy.

Patients with Duchenne's muscular dystrophy often develop progressive scoliosis. Should spinal stabilization be necessary, these patients are considered at high risk for surgically related complications. This retrospective study of 30 patients with Duchenne's examined the prevalence and types of complications associated with posterior spinal fusion and determined the percentage of patients who lived > or = 2 years beyond surgery. Major complications related to cardiopulmonary compromise, infection, or hardware complications occurred in 27%, and minor complications occurred in another 16%. Seventy-seven percent of the patients lived > or = 2 years beyond their surgery. The majority of patients and their families, including half of those who had major complications, reported that surgery resulted in an improvement in their quality of life. Although complications are common, the benefits realized by the patient with Duchenne's muscular dystrophy with scoliosis reinforce the importance of surgical stabilization.

Adolescent↗
PubMed1990

Late paraparesis due to pseudarthrosis after posterior spinal fusion.

The authors report three cases in which paraparesis related to a pseudarthrosis occurred several years after a posterior spinal fusion, but with a different mechanism (stretching of the spinal cord for progression of the deformity in kyphosis in two cases, and spinal cord compression for bone overgrowth within the canal in the site of pseudarthrosis in the third patient). Treatment was different. Partial correction of the deformity and stabilization of the spine by combined fusion (anterior and posterior) was sufficient in the first two cases for a complete neurological recovery. Posterior spinal cord decompression and stabilization of the spine by combined fusion was necessary for complete recovery in the third.

Adult↗
PubMedDate not supplied

Comparison of parents' and caregivers' satisfaction after spinal fusion in children with cerebral palsy.

The purpose of this study was to delineate parents' and professional caretakers' satisfaction after spinal fusion in children with spasticity and to determine differences in their perceptions. A questionnaire assessing patients' functional improvement after spinal arthrodesis for correcting scoliosis was addressed to 190 parents. An expanded questionnaire was also addressed to 122 educators and therapists working in the care of children with cerebral palsy. Caretakers did not recognize effects of the scoliotic deformity on patients' head control, hand use, and feeding ability. Most of parents and caregivers reported a very positive impact of the surgery on patients' overall function, quality of life, and ease of care. Parents had more appreciation of the benefits in the children's appearance, whereas educators and therapists acknowledged more improvement in gross and oral motor function. Considering that the benefits from scoliosis correction clearly outweigh the increased risk of surgical complications, most parents (95.8%) and caretakers (84.3%) would recommend spine surgery.

Adolescent↗
PubMed1997

Pseudarthrosis: US evaluation after posterolateral spinal fusion: work in progress.

PURPOSE: To determine the value of ultrasound (US) in evaluation of pseudarthrosis after posterolateral spinal fusion. MATERIALS AND METHODS: In 10 patients who had undergone bilateral posterolateral thoracic or lumbar fusion with autologous bone graft and instrumentation more than 9 months previously, US was performed within 1 week before second-look surgery. A total of 20 sites each side of midline were evaluated for the presence of bone graft, solid fusion, clefts, fluid collections, and hardware visibility. US findings were compared with those at surgery. In three patients, standard radiographs were reviewed before US; blinded US evaluation was performed in the remaining seven patients. RESULTS: At US, all 10 sites of pseudarthrosis seen at surgery were identified correctly. Of 10 sites with solid fusion at surgery, US depicted six. At four sites (two patients), fusion was mistaken for or obscured by hardware. Overall, sensitivity was 100%, specificity was 60%, and accuracy was 80%. CONCLUSION: US can play a valuable role in the detection of posterolateral bone graft pseudarthrosis, especially when hardware is present.

Adult↗
PubMed2006

The development and evaluation of a Web-site for patients undergoing spinal fusion.

The purposes of this study are to develop a Web-based information program for patients undergoing spinal fusion, and to evaluate the effect on patients' anxiety and knowledge through a Web-based information program. There was significant difference in the levels of anxiety and knowledge between the two groups after program implementation. There was significant difference in the level of knowledge between before and after education of preadmission patients.

Humans↗
PubMed1983

The progression of idiopathic scoliosis after removal of Harrington instrumentation following spinal fusion.

We have investigated the affect of removal of Harrington rods in 36 patients who had undergone successful spinal fusion for idiopathic scoliosis. In the curves in which further deterioration had taken place even though fusion had been achieved, there was a small improvement in both major and minor curves in the first six months after removal of the rod, followed by complete stabilisation of the curve. A similar tendency to stabilisation was noticed in the curves which had not shown deterioration. We conclude that regression of a curve which has fused following Harrington rod instrumentation occurs when the rod has not been placed according to optimum biomechanical principles. Removal of the rod then relieves the deforming stresses and allows the spine to stabilise.

Adolescent↗