Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation (UNILIF): morbidity, clinical and radiological 2-year outcomes of a 66-patient prospective series.

PURPOSE: To assess clinical and radiological outcomes at 2-year follow-up of one-level minimally invasive transforaminal interbody fusion with unilateral pedicle screw fixation (UNILIF) in the treatment of stable lumbar degenerative diseases. METHODS: From January 1, 2012 to January 31, 2013, we prospectively collected clinical and radiological data on patients with stable degenerative lumbar disease managed by UNILIF in a single institution. Preoperatively and at 2 years, we recorded ODI, SF-12, Quebec and VAS. Interbody fusion was analyzed on radiography and on a CT scan, and sagittal balance was tested on full spine radiography. RESULTS: Mean operation time was 74.5 min ± 16.8, mean blood loss was 130.8 ml ± 210.9. At 2 years, ODI, SF-12, Quebec and VAS were significantly improved (p > 0.005).The fusion rate was 96.8% on radiographic analysis and was 87.9% on CT scan analysis. CONCLUSIONS: One-level UNILIF constitutes an effective alternative for management of stable lumbar degenerative diseases. These slides can be retrieved under Electronic Supplementary Material.

Minimally invasive posterior transforaminal lumbar interbody fusion: One-year postoperative morbidity, clinical and radiological results of a prospective multicenter study of 182 cases.

INTRODUCTION: Interbody fusion is the gold standard treatment for the management of numerous diseases of the spine. Minimally invasive techniques may be more beneficial than conventional techniques. The main goal of this study was to report the one-year postoperative results of a series of posterior lumbar interbody fusions by a minimally invasive technique in relation to improvement in functional outcome, interbody fusion and morbidity. MATERIALS AND METHODS: Between January 2012 and May 2013, 182 patients treated by minimally invasive posterior transforaminal lumbar interbody fusion (TLIF) were included in this prospective multicenter study. Clinical assessment was based on a comparison of the preoperative and one-year postoperative Oswestry (ODI), SF-12 and Quebec Scores and the Visual Analog Scale (VAS). Surgical and postoperative follow-up data were evaluated. Radiological assessment was based preoperative and one-year postoperative full spine teleradiographs. Interbody fusion at one-year was systematically evaluated by CT scan. RESULTS: One hundred and eighty-two patients were included, mean age 58.9 years old. Surgery lasted a mean 101 minutes, mean preoperative bleeding was 143 mL, and mean radiation exposure was 247.4 cGy/cm(2). The rate of postoperative complications was 7.7%. The ODI, the Quebec Score, the SF-12 and the VAS were all significantly improved at one-year (P<0.0001). The rate of fusion was 72.6% at the final follow-up. There was no significant difference in functional outcome between patients with and without fusion. DISCUSSION: The one-year postoperative radiological results and functional outcome of minimally invasive posterior lumbar fusion are satisfactory. The benefits of this minimally invasive approach are mainly found in the first 6 postoperative months. Successful radiological interbody fusion was not correlated to functional outcome at the final follow-up.

Fascial flap protecting the fibular nerve: a rare childhood case.

Compression of the peripheral nerves (PNs) induces intraneural lesions, which, once surgical decompression has been achieved, requires that the peripheral scar tissue be as non-adherent as possible. This allows optimal nerve tissue regeneration and the flexibility necessary for longitudinal movements of the PNs. In cases showing a risk for adherence, tissue interposition (with fat, muscle, fascia, etc.) can be proposed. The authors describe the use of a fascial flap of the fibular muscles used to protect the fibular nerve (FN) and the fibula head. This flap procedure was performed in a case of PN compression due to exostosis of the fibular nerve in a child.

Applications in hip pathology.

Everyday clinical practice frequently leads us to suspect a close relationship between the lumbar spine and the hip-joints. Sagittal balance fundamentally expresses a postural strategy mobilizing the dynamic structure of the lumbar-pelvic-femoral complex in an authentic balance by which obligatory coupled movements transmit stresses in a single structure, the spine, to the two-part structure of the lower limbs, and vice-versa. Flexion contracture is a frequent hip pathology, but congenital dislocation and ankylosis of the hip have the greatest impact on the spine, due to excessive mechanical strain and/or spinal malalignment, which is initially supple but becomes fixed. Clinical analysis, backed up if necessary by infiltration tests and imaging, guides indications for surgical management. These considerations suggest a general attitude that considers not just the hip itself, for which the patient is consulting, but the lumbar-pelvic-femoral complex as a whole (and also the knee) before undertaking total hip replacement. Femoro-acetabular impingement is a recently described pathology associating morphological hip-joint abnormality and labral and joint cartilage lesions, leading to early osteoarthritis of the hip. Abnormal spinal or pelvic parameters have not been found associated with femoro-acetabular impingement. Congenital pelvic tilt is a benign and often overlooked pathology in children. Supra- and infra-pelvic pelvic tilt in childhood palsy raises the difficult strategic issue of how to get these children in their wheelchair with a well-balanced spine over a straight pelvis and frontally and sagittally balanced hips.

[A new technique of osteotomy for femoral varisation in the management of hip dislocation and paralytic subluxation of the hip]. / Une nouvelle technique d'ostéotomie fémorale de varisation dans le traitement des luxations et subluxations paralytiques de hanche.

PURPOSE OF THE STUDY: Severe valgus deformity of the upper femur is a frequent feature of the unstable paralytic hip. Thus, the insertion of the osteosynthesis material during a varization osteotomy can be technical demanding. Risks and benefits of a modified femoral varization osteotomy were evaluated in a retrospective follow-up study. MATERIAL: 53 paralytic hips (33 patients) have been operated from September 1989 to april 1993. Mean age at surgery was 6 years. The etiologies were Spinal Amyotrophy in 12 hips, Cerebral Palsy in 31 hips and miscellaneous neurologic diseases in 10 hips. The average neck-shaft angle before surgery was 162 degrees. The mean Reimers' Index was 58 per cent. METHODS: The upper femoral shaft was exposed by subperiosteal dissection in a circumferential manner. An intertrochanteric osteotomy was carried out. The direction of the femoral neck was identified. An AO 100 degree blade plate was then introduced under direct visual control through the cancellous osteotomy surface of the proximal fragment. Radiological and clinical outcome were assessed at last follow-up. Mean follow-up was 16 months. RESULTS: Solid fusion was obtained in all patients. The mean postoperative neck-shaft angle was 104 degrees. The mean Reimers' Index was 17 per cent at last follow-up. Two infections were noted. Voluminous calcifications under the femoral neck have been observed in 6 cases. Recurrence of the valgus deformity was noted in 9 hips at last follow-up. DISCUSSION: This simplified varization technique permits a large amount of varization. The medialization diminishes the problem of protruding hardware. The complications rate appears to be low without any femoral head necrosis in this series despite subperiosteal dissection of the femoral neck. CONCLUSION: The authors think that this modified varization technique may deserve consideration in the treatment of the unstable paralytic hip.