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1.
Spine (Phila Pa 1976) ; 34(8): 832-9, 2009 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-19365253

RESUMO

STUDY DESIGN: Retrospective cohort study of consecutive patients undergoing primary fusion with segmental fixation for adult spinal deformity. OBJECTIVE: We sought to determine the survivorship of primary fusion for adult spinal deformity and identify patient-specific predictors of complications requiring reoperation. SUMMARY OF BACKGROUND DATA: Compared with the adolescent population, surgery for adult deformity is often more complex and technically difficult, contributing to a high reported rate of complications that can result in the need for reoperation. Reported complication rates vary widely. METHODS: From 1999-2004 all patients who underwent primary instrumented fusion for nonparalytic adult spinal deformity at a single center were included. Inclusion criteria included minimum age at surgery of 20 years and minimum fusion length of 4 motion segments. Surgical, demographic, and comorbidity data were recorded. Reoperation was defined as any additional surgery involving levels of the spine operated on during the index procedure and/or adjacent levels. Comparisons were performed between patients who required reoperation and those who did not. RESULTS: Eighty-nine patients met inclusion criteria. Endpoint (minimum 2 years follow-up or reoperation) was reached for 91%. Mean follow-up was 3.8 years. Cumulative reoperation rate was 25.8%. Survival was 86.4% at 1 year, 77.2% at 2 years, and 75.2% at 3 years. Reasons for reoperation included infection (n = 8), pseudarthrosis (n = 3), adjacent segment problems (n = 5), implant failure (n = 4), and removal of painful implants (n = 3). Multivariate analysis showed smoking was significantly higher in the reoperation group. CONCLUSION: Using a strict definition of reoperation for a well-defined cohort, in the presence of relevant risk factors, many patients undergoing primary fusion for adult spinal deformity required reoperation. The results indicate that complex medical and surgical factors contribute to the treatment challenges posed by patients with adult spinal deformity. This represents the largest cohort reported to date of patients undergoing primary fusion using third-generation instrumentation techniques.


Assuntos
Escoliose/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Spine (Phila Pa 1976) ; 34(6): 578-83, 2009 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19240667

RESUMO

STUDY DESIGN: Retrospective case control study. OBJECTIVE: Determine the impact of infection on clinical outcome in patients undergoing posterior spinal fusion surgery. SUMMARY OF BACKGROUND DATA: The outcome of patients treated for infection after spinal surgery is not well established because of variability in cohort identification, definition of infection, outcomes instrument, use of a control group, and/or sample size. METHODS: Thirty-two patients were included. Sixteen patients ("infection group") met inclusion criteria of deep wound infection after spinal fusion with posterior segmental instrumentation (including combined approach). A 1:1 matched cohort ("control group") was created based on primary or revision status, length of fusion, diagnosis, and age. Postoperative patient outcomes were evaluated using the physical components of SF-36 v2.0 with minimum 2-year follow-up. RESULTS: No significant difference in the Physical Function, Role Physical, Bodily Pain, and General Health domains was detected between the infection group and control group. Mean follow-up was 62 months. Mean Physical Component Summary was 41.4 in the infection group and 44.3 in the control group (P = 0.6). Infection occurred early in 12 patients and late in 4 patients. Most common organisms isolated were Staphylococcus epidermidis, Enterococcus sp., and Staphylococcus aureus. Multiple debridements were significantly associated with polymicrobial infections and later pseudarthrosis requiring reoperation. CONCLUSION: An aggressive approach to deep wound infection emphasizing early irrigation and debridement allowed preservation of instrumentation and successful fusion in most cases. At the conclusion of treatment, patients can expect a medium-term clinical outcome similar to patients in whom this complication did not occur.


Assuntos
Desbridamento , Fusão Vertebral/efeitos adversos , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Irrigação Terapêutica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escoliose/cirurgia , Infecções Estreptocócicas/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
Spine J ; 7(4): 451-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17630143

RESUMO

BACKGROUND CONTEXT: Percutaneous discectomy can be performed by a variety of methods. One method, electrosurgical ablation, has been shown in a chronic animal model to alter the expression of inflammatory cytokines in degenerated discs. PURPOSE: To determine whether electrosurgical ablation has an acute direct effect on proinflammatory mediator production by disc cells. STUDY DESIGN: A short-term in vitro study using normal and interleukin (IL)-1alpha stimulated porcine disc cells cultured in alginate gel to evaluate the biochemical effects of electrosurgical ablation. METHODS: Porcine annulus and nucleus cells were embedded into alginate gels and cultured using control culture media or IL-1alpha-treated media for 6 days before ablation treatment. Treated gels were ablated by using a radiofrequency-based electrosurgical device for 5 seconds and cultured an additional 3 or 6 days. IL-1beta, IL-6, IL-8, tumor necrosis factor alpha (TNF-alpha), prostaglandin E2 (PGE2), nitric oxide (NO), and heat shock protein-70 (Hsp70) levels in culture medium were measured. Levels were normalized to DNA and compared between ablated and shams. RESULTS: For normal annulus cells, there were no significant changes in cytokine levels between ablation and sham groups. For normal nucleus cells, ablation produced significantly greater levels of IL-8 at 3 days and 6 days, Hsp70 at 3 days but not 6 days, and NO at 6 days. PGE2 was also increased at 3 days and 6 days but not significantly. For IL-1-stimulated annulus cells, IL-6 and NO in the ablation group were decreased at 3 days relative to the control group. However, IL-6, IL-8, PGE2, and Hsp70 were significantly increased in the 6-day ablation group. For degenerated nucleus cells, IL-6, IL-8, and TNF-alpha were significantly decreased in the ablation group at both 3 days and 6 days. Ablation resulted in reduced PGE2 at 3 days but not 6 and reduced Hsp70 and NO at 6 days. CONCLUSIONS: The results show that electrosurgical ablation has an acute direct effect on proinflammatory mediator production by disc cells. The effect produced depends on disc cell phenotype, the mediator, and time. These direct biologic effects may be a mechanism of pain relief after percutaneous discectomy using electrosurgical ablation. However, the measured responses are limited to the short-term (1 week), and the existence of a prolonged effect remains to be determined.


Assuntos
Citocinas/biossíntese , Eletrocirurgia , Mediadores da Inflamação/metabolismo , Disco Intervertebral/metabolismo , Disco Intervertebral/cirurgia , Animais , Ablação por Cateter , Células Cultivadas , Citocinas/antagonistas & inibidores , Dinoprostona/biossíntese , Eletrocirurgia/métodos , Proteínas de Choque Térmico HSP72/biossíntese , Mediadores da Inflamação/antagonistas & inibidores , Interleucina-1alfa/farmacologia , Disco Intervertebral/citologia , Disco Intervertebral/efeitos dos fármacos , Suínos , Fatores de Tempo
4.
Neurosurg Clin N Am ; 18(2): 261-72, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17556127

RESUMO

Degenerative scoliosis is a common and important cause of lumbar spine deformity in the adult. The operative management of degenerative scoliosis encompasses a spectrum of approaches, including decompression alone, or fusion that may include posterior or anterior approaches. There exists significant variability in surgical approaches to degenerative scoliosis, and evidence to support a specific approach is limited. Including the structural thoracic spine in fusions to the thoracolumbar junction has a lower rate of revision than fusions with a cephalad segment at T12 or L1. Short fusions to L5 have a low rate of revision at a minimum follow-up of 2 years. Combined anterior and posterior surgery is more effective in improving lordosis than posterior-only surgery without osteotomies. Clinical outcomes of surgery for degenerative scoliosis are variable, andwct 2 self-reported scores for pain improve more reliably than scores for function. Further investigation, including comparison of randomized or matched cohorts and measurement of outcomes related to specific preoperative complaints, will be useful in the development of an evidence-based approach to degenerative scoliosis.


Assuntos
Escoliose/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/diagnóstico por imagem , Fusão Vertebral , Vértebras Torácicas , Resultado do Tratamento
5.
Neurosurg Clin N Am ; 18(2): 281-8, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17556129

RESUMO

The treatment of adult spinal deformities often involves long thoracolumbar fusions into the lower lumbar spine, raising the debate of selecting L5 or S1 as the caudal extent of the fusion. The presence of significant deformity or degenerative pathologic findings at L5-S1 mandates fusion to the sacrum. Fusion to the sacrum is of larger magnitude than fusion to L5 and introduces a higher surgical complication rate. Advantages of ending the fusion at L5 include preservation of motion, avoiding the high complication rate associated with fusion to the sacrum, and possibly avoiding a second operation. Complications with fusion to L5 include possible loss of fixation and subsequent disc degeneration at L5-S1, however, leading to possible pain and loss of sagittal balance and the need for revision surgery. To date, the functional consequences of an open disc space beneath long constructs remain poorly defined, and there is no firm evidence in the literature guiding the surgeon's choice. The issues and evidence guiding the decision to fuse to L5 or S1 are examined in this article.


Assuntos
Escoliose/cirurgia , Fusão Vertebral/métodos , Adulto , Humanos , Vértebras Lombares , Sacro
6.
Clin Orthop Relat Res ; 457: 87-95, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17290153

RESUMO

In recent decades American medicine has undergone tremendous changes. Numerous reimbursement and systems approaches to controlling medical inflation and improving quality have failed to provide cost-effective, high-quality health care in most circumstances. Public and private payers are currently implementing pay for performance, a new reimbursement method linking physician pay to evidence of adherence to performance measures, to constrain costs, encourage efficiency, and maximize value for health care dollars. High-quality research regarding pay for performance and its impact is scarce, particularly in orthopaedic surgery. Although supporters argue pay for performance will remedy the fragmented, costly delivery of health services in the United States, skeptics raise concerns about disagreement over quality guidelines, financial implications for providers and hospitals, inadequate infrastructure, public reporting, system gaming, and physician support. Our survey of orthopaedic surgeons reveals limited understanding of pay for performance, marked skepticism of nonphysician stakeholders' intentions, and a strong desire for greater clinician involvement in shaping the pay for performance movement. As pay for performance will likely be a long-term change that will have an impact on every orthopaedic surgeon, clinician awareness and participation will be fundamental in creating successful pay for performance programs.


Assuntos
Honorários Médicos , Ortopedia/economia , Planos de Incentivos Médicos , Competência Profissional , Reembolso de Incentivo , Humanos , Ortopedia/normas
8.
Spine (Phila Pa 1976) ; 30(12): 1460-5, 2005 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-15959380

RESUMO

STUDY DESIGN: A retrospective case control analysis of 48 cases of postoperative infection following spinal procedures. OBJECTIVES: Spinal procedures that became infected after surgery were analyzed to identify the significance of preoperative and intraoperative risk factors. Characterization of the nature and timing of the infections was also performed. SUMMARY OF BACKGROUND DATA: The rate of postoperative infection following spinal surgery varies widely depending on the nature of the procedure and the patient's diagnosis. Preoperative comorbidities and risk factors also influence the likelihood of infection. METHODS: A review of 1629 procedures performed on 1095 patients revealed that a postoperative infection developed in 48 patients (4.4%). Data regarding preoperative and intraoperative risk factors were gathered from patient charts for these and a randomly selected control group of 95 uninfected patients. For analysis, these patient groups were further divided into adult and pediatric subgroups, with an age cutoff of 18 years. Preoperative risk factors reviewed included smoking, diabetes, previous surgery, previous infection, steroid use, body mass index, and alcohol abuse. Intraoperative factors reviewed included staging of procedures, estimated blood loss, operating time, and use of allograft or instrumentation. RESULTS: The majority of infections occurred during the early postoperative period (less than 3 months). Age >60 years, smoking, diabetes, previous surgical infection, increased body mass index, and alcohol abuse were statistically significant preoperative risk factors. The most likely procedure to be complicated by an infection was a combined anterior/posterior spinal fusion performed in a staged manner under separate anesthesia. Infections were primarily monomicrobial, although 5 patients had more than 4 organisms identified. The most common organism cultured from the wounds was Staphylococcus aureus. All patients were treated with surgical irrigation and débridement, and appropriate antibiotics to treat the cultured organism. CONCLUSIONS: Aggressive treatment of patients undergoing complex or prolonged spinal procedures is essential to prevent and treat infections. Understanding a patient's preoperative risk factors may help the physician to optimize a patient's preoperative condition. Additionally, awareness of critical intraoperative parameters will help to optimize surgical treatment. It may be appropriate to increase the duration of prophylactic antibiotics or implement other measures to decrease the incidence of infection for high risk patients.


Assuntos
Procedimentos Ortopédicos/efeitos adversos , Doenças da Coluna Vertebral/epidemiologia , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , California/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/patologia , Coluna Vertebral/microbiologia , Coluna Vertebral/patologia
9.
J Bone Joint Surg Am ; 86(3): 561-8, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14996883

RESUMO

BACKGROUND: Craniovertebral arthrodesis in the upper cervical spine is challenging because of the high degree of mobility afforded by this region. A novel method for achieving atlantoaxial fixation with use of polyaxial screws inserted bilaterally into the lateral masses of C1 and transpedicularly into C2 with longitudinal rod connection has recently been introduced. The question remains as to whether this technique provides adequate stability when extended cephalad to include the occiput. The purpose of this study was to determine the primary stability afforded by this novel construct and compare its stability with the current standard of bilateral longitudinal plates combined with C1-C2 transarticular screws. METHODS: We used ten fresh-frozen human cadaveric cervical spines (C0-C4). Pure moment loads were applied to the occiput, and C4 was constrained during the testing protocol. We evaluated four conditions: (1) intact, (2) destabilized by means of complete odontoidectomy, (3) stabilization with longitudinal plates with C1-C2 transarticular screw fixation, and (4) stabilization with a posterior rod system with C1 lateral mass screws and C2 pedicle screws. Rigid-body three-dimensional rotations were detected by stereophotogrammetry by means of a three-camera system with use of marker triads. The range of motion data (C0-C2) for each fixation scenario was calculated, and a statistical analysis was performed. RESULTS: Destabilization of the specimen significantly increased C0-C2 motion in both flexion-extension and lateral bending (p < 0.05). Both fixation constructs significantly reduced motion in the destabilized spine by over 90% for all motions tested (p < 0.05). No significant differences were detected between the two constructs in any of the three rotational planes. CONCLUSIONS: Both hardware systems provide equivalent construct stability in the immediate postoperative period when it is critical for the eventual success of a craniovertebral arthrodesis. On the basis of this work, we believe that the decision to use either construct should be determined by clinical rather than biomechanical concerns.


Assuntos
Artrodese/métodos , Articulação Atlantoccipital , Vértebras Cervicais/cirurgia , Instabilidade Articular/cirurgia , Idoso , Análise de Variância , Artrodese/efeitos adversos , Artrodese/instrumentação , Fenômenos Biomecânicos , Placas Ósseas/normas , Parafusos Ósseos/normas , Cadáver , Humanos , Fixadores Internos , Instabilidade Articular/fisiopatologia , Teste de Materiais , Processo Odontoide/cirurgia , Osteotomia/métodos , Seleção de Pacientes , Amplitude de Movimento Articular , Rotação , Resistência à Tração , Resultado do Tratamento
10.
Spine (Phila Pa 1976) ; 28(15): 1710-5; discussion 1716, 2003 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-12897497

RESUMO

STUDY DESIGN: Retrospective study of consecutive patient series. OBJECTIVES: To review the radiographic and clinical results of patients with preoperative fixed sagittal imbalance treated with combined anterior and posterior arthrodesis, and to determine factors that predict clinical outcome. SUMMARY OF BACKGROUND DATA: Combined anterior and posterior arthrodesis of the spine is useful in the management of fixed deformity involving the coronal and sagittal planes. The specific indications for combined surgery in the patient with regional and global imbalance have not been well defined. METHODS: Retrospective review of 25 consecutive patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria included a preoperative global sagittal imbalance of at least 5 cm. Outcome variables included radiographic measures of preoperative, postoperative, and follow-up films, and a clinical assessment using the Modified SRS Outcomes Instrument and a review of postoperative complications. RESULTS: Twenty-five consecutive cases were reviewed. Mean age was 58 years (range 38-77), and mean follow-up was 55 months (range 24-81) for clinical and 44.5 (range 24-81) months for radiographic outcome variables. The mean preoperative sagittal imbalance was 10.5 cm (range 5.2-23.3), which improved to 2.9 cm (range 0-12.6) after surgery, and was maintained as 3.3 cm (range 0-13.5) at follow-up. Mean lumbar lordosis was -23 degrees (range +40 to -47) before surgery, and increased to -42 degrees at follow-up (range -20 degrees to -60 degrees ), an increase of 19 degrees. Patients with preoperative regional hypolordosis in the lumbar spine that was corrected surgically had the highest postoperative scores. The mean score for patient satisfaction with surgical management was 4.45 (range 2.5-5). Correlation analysis of clinical outcome domains demonstrated that patient satisfaction correlated poorly with domains of pain (r = 0.37, P = 0.1) and function (r = 0.4, P = 0.09). Within the domains, self-image showed highest correlation with patient satisfaction (r = 0.65, P = 0.006) and total score (r = 0.89, P = 0.0001). CONCLUSIONS: Patients with global sagittal imbalance of the spine were effectively treated with a combined anterior and posterior arthrodesis as measured by radiographic parameters. Patient satisfaction with surgery, and overall clinical outcomes were best in cases that resulted in an increase in lumbar lordosis. The subset of patients with preoperative regional hypolordosis of the lumbar spine has better outcomes than those with preoperative lumbar lordosis in the physiologic range.


Assuntos
Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Seguimentos , Humanos , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Radiografia , Estudos Retrospectivos , Escoliose/cirurgia , Resultado do Tratamento
11.
Spine (Phila Pa 1976) ; 27(5): 529-34, 2002 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-11880839

RESUMO

STUDY DESIGN: Retrospective review of cases in which a single solid rod was used for the anterior correction of thoracolumbar and lumbar idiopathic scoliosis in adults. OBJECTIVES: To evaluate the efficacy and outcomes in these patients. SUMMARY OF BACKGROUND DATA: Anterior spinal fusion with instrumentation has been found to be kyphogenic in the treatment of scoliosis. Recent reports have shown an extremely high rate of pseudarthrosis and implant failure even in adolescents who have undergone anterior spinal fusion with a single flexible or rigid rod. METHODS: Fifteen consecutive adult patients with (average age, 37.5 years) had undergone anterior spinal fusion with a rigid rod were included in this study. One was lost to follow-up, leaving 14 patients with a complete radiographic follow-up of 44 months and clinical follow-up of 61 months. Patients were sent the Modified Scoliosis Research Society (SRS) Outcomes Instrument, charts were reviewed, and preoperative, postoperative, and final follow-up films of the entire spine were evaluated by independent reviewers uninvolved in the care of the patients. RESULTS: The average preoperative major curve was 50 degrees, which improved to 16 degrees at follow-up (a 66% correction). The average correction of the upper compensatory curve and lower fractional curve were 40% and 61%, respectively. The thoracolumbar sagittal plane alignment was maintained or improved in all patients (i.e., this surgery did not induce kyphosis in any patient). On average 0.9 levels were "saved" compared with levels chosen by the authors for posterior surgery. All patients achieved a solid fusion. Follow-up Modified SRS questionnaires revealed a satisfaction score 4.5 out of a possible score of 5, a pain score of 4.1 out of 5, a self-image score of 4.1 out of 5, a function score of 4.1 out of 5, and a mental health score of 4.0 out of 5, with an overall score of 82%. All patients but one were satisfied or extremely satisfied with the results of surgery. There was no incidence of implant breakage. CONCLUSIONS: The results of anterior spinal fusion using a single solid rod in adults with idiopathic scoliosis in this series are excellent, with 100% fusion rate, no development of kyphosis, and no incidence of hardware failure.


Assuntos
Cifose/etiologia , Próteses e Implantes , Pseudoartrose/etiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Parafusos Ósseos/efeitos adversos , Segurança de Equipamentos , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Satisfação do Paciente , Próteses e Implantes/efeitos adversos , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral/instrumentação , Resultado do Tratamento
12.
Spine (Phila Pa 1976) ; 27(7): 776-86, 2002 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-11923673

RESUMO

STUDY DESIGN: A retrospective study of adults with long fusion to the sacrum using three different fixations was performed. OBJECTIVE: To compare the long-term clinical results and complications associated with three methods of lumbosacral fixation for adult spine deformities: Luque-Galveston, combined iliac and sacral screws, and sacral screws. SUMMARY OF BACKGROUND DATA: The preferred technique for long fusion to the sacrum is controversial, and surgery for adult deformity is fraught with significant technical difficulties and high complication rates. No clinical study compares the long-term outcome of long fusion to the sacrum using these different methods of lumbosacral fixation. METHODS: This study included 54 consecutive patients who underwent elective combined anterior and posterior surgical reconstruction for adult spine deformity with a minimum follow-up period of 2 years. The patients were divided into three groups on the basis of the surgical method used for the posterior spine instrumentation. Group 1 consisted of 11 patients with smooth L-rod and segmental sublaminar wire instrumentation (Luque-Galveston technique). Group 2 consisted of 36 patients with posterior Isola segmental instrumentation and combined iliac and sacral screws. Group 3 consisted of 12 patients with Isola segmental instrumentation using bicortical sacral screws. Five patients were revised to another fixation group, giving a total of 59 cases. Radiographic, clinical results, and long-term outcome data were obtained using the modified Scoliosis Research Society (SRS) outcome instrument. RESULTS: There were 26 late complications. Pseudarthrosis developed in 10 patients, requiring revision surgery: 4 (36%) in the Group 1, 5 (14%) in Group 2, and 1 (8.5%) in Group 3. Comparison of the modified SRS outcomes showed no difference among the groups. The average SRS grand total score was 73.4% for Group 1, 70.9% for Group 2, and 62.6% for Group 3. Overall, 76% of the patients were satisfied with their outcome. The presence of perioperative complications or pseudarthrosis significantly correlated with a lower satisfaction score (P = 0.012 and P = 0.048, respectively). Sagittal plane decompensation significantly correlated with a higher pain score (P = 0.035). Patients with prior surgeries scored lower on the self-image questions than patients with no prior surgery (P = 0.007). CONCLUSIONS: Attention to sagittal balance is critical in these patients. Revision surgery is as safe and effective as primary surgery. According to the current findings, the Luque-Galveston fixation technique has an unacceptably high rate of pseudarthrosis, and this method is not recommended for adult deformities. Currently, the authors are using bicortical and triangulated sacral screws with an anterior interbody support in patients with good bone stock, but only when the spine balance is restored. Otherwise, they recommend using iliac fixation, although there is a higher rate of painful hardware, requiring removal.


Assuntos
Ílio/cirurgia , Sacro/cirurgia , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Pinos Ortopédicos , Parafusos Ósseos , Fios Ortopédicos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
13.
Spine (Phila Pa 1976) ; 27(4): 423-7, 2002 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-11840110

RESUMO

STUDY DESIGN: Questionnaire-based survey. OBJECTIVES: To poll the members of the Scoliosis Research Society regarding their opinions and experience with athletic activity after spine surgery performed on children and adolescents. SUMMARY OF BACKGROUND DATA: Athletic activity is increasingly important in society. Patients are very concerned about returning to sports and exercise after spinal surgery. There are no generally accepted guidelines for surgeons regarding either appropriate sports or the appropriate time to resume sports after spinal surgery. METHODS: A survey was designed by the authors and reviewed by a statistical consultant. The form was mailed to the 721 individuals on the Scoliosis Research Society mailing list. Returned surveys were hand scored and entered into an Excel spreadsheet. RESULTS: Of the 316 forms returned, 278 indicated that the respondent performed spinal fusion on children and adolescents. Two hundred sixty-one completed forms, representing approximately 45% of the society's estimated active clinicians, were reviewed. Formal physical therapy was unlikely to be recommended by members of the society regardless of procedure, although postoperative home exercise was used by many after spondylolisthesis fusion. The majority of patients were returned to gym class between 6 months and 1 year (range, immediate to never) after surgery. Most respondents returned patients to noncontact sports between 6 months and 1 year postoperatively. Contact sports were generally withheld until 1 year after surgery. Close to 20% of respondents required, and 35% suggested, that patients never return to collision sports. Twenty percent of respondents for scoliosis and 5% for spondylolisthesis reported having notable adverse outcomes attributed to athletic activity. CONCLUSION: These survey results show the varying approaches taken by members of the Scoliosis Research Society to postoperative athletic activity, and they provide a starting point for investigations regarding alternative approaches.


Assuntos
Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Esportes , Adolescente , Criança , Conhecimentos, Atitudes e Prática em Saúde , Diretrizes para o Planejamento em Saúde , Humanos , Período Pós-Operatório , Escoliose/complicações , Escoliose/cirurgia , Sociedades Médicas/estatística & dados numéricos , Fusão Vertebral/reabilitação , Espondilolistese/complicações , Espondilolistese/cirurgia , Inquéritos e Questionários
14.
Clin Orthop Relat Res ; (394): 84-91, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11795755

RESUMO

Anterior structural support plays an important role in spinal deformity surgery. Femoral ring allografts have been widely used for this purpose despite numerous alternative implants such as cages. The literature and the authors' experience support the use of femoral ring allograft as a structural and biologic compatible implant to reconstruct anterior column defects. Pseudarthrosis rates and the rate of subsidence and loss of correction are low. No long-term studies exist that show that cages are superior in correction of deformity. Femoral ring allograft remains a viable, cost-effective, and biologic sound alternative.


Assuntos
Transplante Ósseo/métodos , Fêmur/transplante , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Prognóstico , Radiografia , Amplitude de Movimento Articular/fisiologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/diagnóstico por imagem , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento
15.
Surg Technol Int ; I: 393, 1991 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28581623

RESUMO

Recent advances in orthopaedic technology have been among the most exciting medical developments of the past decade. More than 90 percent of the procedures and implants in use today did not exist a decade ago. The development of new prostheses and implants, the modifications of existing ones, and the development of new surgical techniques have allowed orthopaedic surgeons to treat and rehabilitate patients with diseases and deformities that were previously unmanageable. Furthermore, the newer and less invasive procedures have decreased the cost of treatment and recovery time for many patients. Prosthetic joint replacement is now capable of relieving arthritic pain in a predictable fashion, and spinal deformities of any magnitude can be treated in patients of any age with a high probability of success. The reattachment of amputated parts has become commonplace, and techniques of tissue transfer have enabled the salvage and reconstruction of cancerous or traumatised limbs that previously would have been lost to amputation.

16.
Surg Technol Int ; I: 401-405, 1991 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28581625

RESUMO

Technological advances in the field of spine surgery have most often involved instrumentation. In recent years, a great deal of attention has been focused on variable hookscrew-rod systems, the prototype of which is the Cotrel-Dubousset instrumentation (CDI). This French-designed system and similar ones such as the Texas-Scottish Rite (TSRH), or the Isola, provide significantly better fixation and rigidity than has ever been possible, and they allow many patients to be spared the discomfort and inconvenience of post-operative brace or cast support. These features are particularly important for older and chronically ill patients, whose often difficult problems can also be addressed more safely and effectively with this new technology.

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