Spinal Versus General Anesthesia for Lumbar Decompression or Sequestrectomy in Patients Over 75 Years.

BACKGROUND CONTEXT: Decompression or sequestrectomy in the lumbar spine can be performed under general (GA) or regional anesthesia. In elderly patients, it is still not clear, which procedure should be chosen. OBJECTIVE: To demonstrate that spinal anesthesia (SA) is a safe choice for lumbar decompression or sequestrectomy in elderly patients. DESIGN: Retrospective clinical single-center study. PATIENTS SAMPLE: We included 154 patients with ages over 75 years after lumbar decompression or sequestrectomy. The mean age of the patients was 81 years. OUTCOME MEASURES: Perioperative data (blood loss, dural tear, operative and perioperative time, delirium, urinary retention, and hospital stay) and the postoperative 1-year follow-up (visual analog scale and complication rate). PATIENTS AND METHODS: Data were retrospectively collected from patients that underwent lumbar decompression or sequestrectomy between January 2019 and December 2020. The data from the GA and SA groups were compared. RESULTS: SA was performed in 56 patients whereas 98 patients received a GA. There was no clinically relevant difference between both groups with comparable complication rates. The time of surgery, blood loss, perioperative time, and hospital stay time were significantly less in the SA group. CONCLUSIONS: SA and GA are both safe and reliable procedures for lumbar decompression or sequestrectomy in elderly patients with no clinically relevant difference.

Herniectomy versus herniectomy with the DIAM spinal stabilization system in patients with sciatica and concomitant low back pain: results of a prospective randomized controlled multicenter trial.

PURPOSE: To investigate the short and medium term efficacy and patient outcomes of DIAM spinal stabilization system on back pain, disability, leg pain and quality of life. METHODS: 165 patients were enrolled; 146 patients with a single level disc herniation (L2 to L5) were randomized: 75 investigational (herniectomy and DIAM) and 71 control (herniectomy alone) treated and followed up for 24 months. RESULTS: Significant improvements overtime (P < 0.001) in both groups but not significantly different between groups for visual analog scale (VAS) back pain at 6 months (investigational -3.97 ± 2.55 vs control-3.37 ± 3.15, P = 0.228) and Oswestry Disability Index (ODI) at 12 months (-38.55 ± 20.10 vs -37.19 ± 22.61, P = 0.719). For both outcomes, there was no statistically significant difference between the groups, at all postoperative time points. Although the enrolment ended before the intended sample size (308 patients) was reached, the number of patients reaching the VAS back pain minimally clinically important difference (MCID) of ≥2.2 at 6 months was higher in the investigational (79.4 % vs control 57.1 %, P = 0.008). These results were sustained throughout 24 months (82.8 vs 64.4 %, P < 0.05). In average, surgical duration (P < 0.001), blood loss (P = 0.029) and skin incision (P < 0.001) in the investigational were 10 min longer, 22.5 ml greater and 2.0 cm wider than control group (median values). Improved tertiary outcomes from BL to 24 mo in both groups (investigational vs control): VAS leg pain (mean decrease -6.41 ± 2.57 to -6.41 vs -5.61 ± to -3.30); improved quality of life (SF-36: 20.68 ± 9.44 vs 16.90 ± 10.74); pain medication reduction: 56.7 vs 47.9 %; return to work: 45.7 vs 38.0 %. Adverse event rates: 68.5 % investigational and 66.2 % control. CONCLUSIONS: This is the first randomized controlled trial to report equivalent efficacy and safety of herniectomy with or without DIAM spinal stabilizing device. Leg pain, back pain and the level of disability were not significantly different between groups; however, number of patients reaching the MCID for back pain was significantly higher in the investigational group at 6 through 24 months.

The migration of a BioScrew as a differential diagnosis of knee pain, locking after ACL reconstruction: a report of two cases.

INTRODUCTION: Problems with the initial fixation strength and widening of the femoral and tibial canal after ACL reconstruction using a triple or quadruple semitendinosus autograft have led to the introduction of the so-called Hybrid fixation with the additional use of interference screws. Pain and intraarticular migration have been reported with metal interference screws requiring implant removal (Am J Knee Surg 11:32-34, 2000, Arthroscopy 11:289-291, 1995) but not yet with bioabsorbable screws. MATERIALS AND METHODS: We report on two cases were the intraarticular position of a bioabsorbable interference screw possibly due to migration in the early postoperative period lead to symptoms, the need for further surgery, and implant removal. RESULTS: A preoperative MRI revealed the diagnosis. After removal of the tibial interference screw both knees were settling down, albeit with residual instability and only a moderate clinical result. DISCUSSION: Despite the attractiveness of bioabsorbable screws due to the very fact that they are being reabsorbed over time, there is a slight risk of migration in the first month after the operation. In any suspicious case an MRI will easily clarify the diagnosis.