Quantitative analysis of local bone graft harvested from the posterior elements during posterior spinal fusion in Adolescent Idiopathic Scoliosis patients.

OBJECTIVE: This study analyses the quantity of local bone graft obtained from different anatomical parts of the posterior elements during corrective surgery for Adolescent Idiopathic Scoliosis patients. SUMMARY OF BACKGROUND DATA: Locally harvested autogenous bone graft eliminates possible donor site morbidity and has all the important basic bone graft properties such as osteoinductivity, osteogenicity and osteoconductivity. Its usage was reported to be adequate to achieve fusion but none had quantifies the amount of local bone graft harvested. METHODS: Total of 40 AIS patients were recruited in the study. All posterior spinal fusion surgeries were performed by the same dual surgeons and same anesthetist with a single observer collecting and measuring bone grafts harvested. The bone grafts harvested from each respective posterior element (spinous processes, laminas, facets and transverses processes) and measured accordingly. RESULTS: There were 36 females and 4 males. Amongst cases recruited, there were 32% Lenke 1, 28% Lenke 2, 8%Lenke 3, 22%Lenke 5 and 10% Lenke 6. Total thoracic levels involved were 333, whereas lumbar levels were 81. The mean total weight of bone graft obtained per case was 36.5 ±â€¯13.7 g. The total weight of lumbar bone graft to the number of lumbar fusion levels (4.5 ±â€¯1.2 g/fusion level) was significantly higher than the total weight of thoracic bone graft to the number of thoracic fusion levels (3.2 ±â€¯1.2 g/fusion level). The amount of bone graft was obtained was highest from lumbar spinous process (42%), followed by thoracic spinous process (32%), lumbar lamina (29%), lumbar facet (28%), thoracic lamina (25%), thoracic facet (22%), and thoracic transverse process (21%). CONCLUSIONS: Lumbar vertebra provided more bone graft than thoracic vertebra. Spinous processes contributed the highest amount of local bone graft in the thoracic and lumbar spine.

Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft?

BACKGROUND: This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty. METHODS: Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated. RESULTS: A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04). CONCLUSIONS: Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.

Feasibility and Outcome of an Accelerated Recovery Protocol in Asian Adolescent Idiopathic Scoliosis Patients.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population. METHODS: Seventy-four AIS (65 F, 9 M) patients scheduled for PSF surgery were recruited. The accelerated protocol encompasses preoperative regime, preoperative day of surgery counseling, intraoperative strategies, an accelerated postoperative rehabilitation and pain management regime. All patients were operated using a dual attending surgeon strategy. Outcome measures included pain scores at five time intervals, length of stay, and detailed recovery milestones. Any complications or readmissions during the first 4 months postoperative period were recorded. RESULTS: Mean duration of operation was 2.2 ±â€Š0.3 hours with a mean blood loss of 824.3 ±â€Š418.2 mL. No patients received allogenic blood transfusion. The mean length of stay was 3.6 ±â€Š0.6 days. Surgical wound pain score was 6.4 ±â€Š2.1 at 12 hours, which reduced to 5.0 ±â€Š2.0 at 60 hours. Abdominal pain peaked at 36 hours with pain scores 2.4 ±â€Š2.9. First liquid intake was at 5.2 ±â€Š7.5 hours, urinary catheter removal at 18.7 ±â€Š4.8 hours, sitting up at 20.6 ±â€Š9.1 hours, ambulation at 27.2 ±â€Š0.5 hours, consumption of solid food at 32.2 ±â€Š0.5 hours, first flatus at 39.0 ±â€Š0.7 hours, and first bowel movement at 122.1 ±â€Š2.0 hours. The complication rate was 1.4% due to superficial wound infection with one patient failed to comply with the accelerated protocol. CONCLUSION: An accelerated recovery protocol following PSF for AIS is feasible without increasing the complication or readmission rates. The total length of stay was 3.6 days and this is comparable with the outcome in western population. LEVEL OF EVIDENCE: 4.