Back Pain

Back Pain

Percutaneous discectomy discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula. The discectomy

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Back Pain

Back Pain

Percutaneous discectomy discectomy is a surgical procedure in which the central portion of an intervertebral disc is accessed and removed through a cannula. The discectomy

Read More
Segmental spinal dysgenesis: a report of early surgical intervention and outcome in a 14-month-old child.

Segmental spinal dysgenesis: a report of early surgical intervention and outcome in a 14-month-old child.

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Segmental spinal dysgenesis: a report of early surgical intervention and outcome in a 14-month-old child.

Childs Nerv Syst. 2017 Feb;33(2):381-384

Authors: Morell SM, McCarthy RE, Ocal E

Abstract
Segmental spinal dysgenesis is a rare spinal deformity that is the result of failure of formation resulting in some cases spondyloptosis and neurological dysfunction usually at the thoracolumbar junction. There is little known concerning surgical intervention and timing in these patients. The goal of this case report is to present a case involving 14 months old diagnosed with segmental spinal dysgenesis with stenosis at the thoracolumbar junction soon after birth, treated with definitive posterior spinal fusion and subsequent follow-up.

PMID: 27613633

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Outcomes of open staged corrective surgery in the setting of adult spinal deformity.

Outcomes of open staged corrective surgery in the setting of adult spinal deformity.

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Outcomes of open staged corrective surgery in the setting of adult spinal deformity.

Spine J. 2017 Mar 21;:

Authors: Passias PG, Poorman GW, Jalai CM, Line B, Diebo B, Park P, Hart R, Burton D, Schwab F, Lafage V, Bess S, Errico T, International Spine Study Group

Abstract
BACKGROUND CONTEXT: Adult spinal deformity (ASD) represents a constellation of complex mal-alignments affecting the spinal column. Corrective surgical procedures aimed at improving ASD can be equally challenging, and commonly require multiple index procedures and potential revisions prior to definitive management. There is a paucity of data comparing the outcomes of same-day (simultaneous) and two-day (staged) procedures for long spinal-fusions for ASD. Utilizing a large patient cohort with surgeon and patient-reported outcomes will be particularly useful in determining the utility and effect of staging long spine fusions for ASD.
PURPOSE: Compare intra-operative, peri-operative, and two-year outcomes of staged and simultaneous procedures correcting ASD.
STUDY DESIGN/SETTING: Retrospective analysis of a prospective multi-center database.
PATIENT SAMPLE: 142 patients (71 Staged, 71 Simultaneous).
OUTCOME MEASURES: Primary: intra- and peri-op (6 wk) complication rates. Secondary: 2 year thoracolumbar and spino-pelvic radiographic parameters, 2 year Health Related Quality of Life changes (Oswestry Disability Index and SF-36), and 2 year complication rates METHODS: Inclusion criteria included ASD patients ≥18yrs with 6-wk and 2 year follow-up. Propensity score matching identified similar patients undergoing staged (STA) or simultaneous (SIM) long spine fusions based on Surgical Invasiveness, Pelvic Tilt, and SVA. Complications, HRQLs (SRS22r, SF-36, ODI), and patient characteristics were compared across and within treatment groups at follow-up with ANOVA and paired t-tests at 3 surgical stages: intra-op, peri-op (6wk), and post-op (>6wk).
RESULTS: 142 patients were included (71 STA, 71 SIM). Matching staged and simultaneous groups based on degree of deformity and surgical invasiveness created two groups similar in overall correction of the surgery. STA patients underwent more ALIF and LLIF interbody procedures while SIM patients had longer fusions. Charlson Comorbidity Index and revision status were similar between groups (p>0.05). There were significantly more complications causing reoperation in STA procedures (STA: 47% SIM: 8%, p=0.021). STA had a greater number of peri-op complications requiring a return to the OR (STA: 9.9% SIM: 1.4% p=0.029). There was no difference in intra-op complications, mortality, or peri-op infection or wound complications (p>0.05). At 2 year follow-up, incidence of revision surgery was higher in STA (STA: 21.1% SIM: 8.5%, p=0.033).
CONCLUSION: Staged spinal fusions which add ALIFs and LLIFs to the procedure, compared to similar-correction simultaneous procedures, result in similar intra-operative complication incidence, but significantly higher rates of peri- and post-op complications leading to revision. Functional outcomes, radiographic parameters, and mortality were similar. This will aid surgeons in their determination of optimal treatment for such complex procedures.

PMID: 28341194

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