Kyphoplasty Augmentation in Thoracolumbar Spine - Clinical Outcomes after 2 Years.

PURPOSE OF THE STUDY With the ageing of population the vertebral insufficiency fractures are increasing in number and occur ever more frequently. Symptomatic relief is often difficult to achieve by non-operative treatment. The aim of this study was to determine the level of pain relief and functional outcomes in patients who failed initial non-operative treatment and, because of persisting or growing symptoms, underwent kyphoplasty. MATERIAL AND METHODS Total number of 303 patients who underwent balloon kyphoplasty between January 2011 and December 2016 were included in our study. These 303 patients had 357 surgeries. This is a retrospective review of a prospectively updated database maintained by our spinal surgery department. In total, 575 levels were augmented. The patients were mostly females (246). The age of the patients ranged from 30 years to 98 years, with the mean age being 72.6 years. The average follow-up for our series was 17.2 months (2-63 months). Pain relief was assessed using the Visual Analogue Scale (VAS) and functional outcome using the Oswestry Disability Index (ODI). RESULTS The average pre-operative VAS was 6.34 (p = 0.00003). At 6 weeks postoperatively the average VAS decreased to 3.80 (p = 0.00000). In our series, the VAS scores showed a progressive decline progressing from the mean value of 3.18 (p = 0.15890) at 1 year to the mean value of 2.85 (p = 0.00205) at 2 years. The average pre-operative ODI was 25.65 (p = 0.03604). At 6 weeks, the value improved to 17.69 (p = 0,00120) and further improvements were seen at 1 year (ODI 14.13) and at 2 years (ODI 12.08). In our series no clinically significant complications were reported. The social drift was observed in 17 patients in our study. DISCUSSION The pain relief and the improvement of functional outcomes were maintained even at a two-year follow-up. No clinically significant complications were reported that would require further surgical intervention and that would affect the good clinical results of our study. CONCLUSIONS Balloon kyphoplasty proved to be a safe surgical technique and should be considered in patients with an ongoing pain following vertebral insufficiency fractures that do not improve with the initial non-operative treatment. Cement augmentation significantly improves pain levels and as well functional status in elderly patients. Key words:cement augmentation, osteoporotic fracture, kyphoplasty, vertebroplasty, osteoporotic spine fracture.

Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression.

BACKGROUND: Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival. METHODS: Muscle mass was calculated as total psoas area (TPA)/ vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases surgery, at the mid L3 vertebral level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. RESULTS: 86 patients were followed for 1 year, with an overall mortality of 39.5%. Mortality rates at 1 year were significantly high among patients in the lowest quartile of muscle mass, compared with those in the highest quartile (57.1 vs 23.8%, p=0.02). CONCLUSION: Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.

A pilot study investigating the use of at-home, web-based questionnaires compiling patient-reported outcome measures following total hip and knee replacement surgeries.

Patient-reported outcome measures (PROMs) are used routinely in NHS. Traditional pen-and-paper questionnaire collection can be time-consuming for both patients and clinic staff. The purpose of the current study was to determine whether a web-based PROMs system has the potential to provide satisfactory patient compliance and whether compiled data are equivalent to pen-and-paper PROMs data. A series of 82 patients who had joint replacement surgery was identified. Each patient was contacted by letter to register on the myClinicalOutcomes.co.uk website and to follow the instructions to render an Oxford score. A second request was sent to those failing to initially register. Telephone contact was then made with non-responders to identify the reason for failed registration. Successfully collated online Oxford scores were compared with previously recorded pen-and-paper scores for each patient from a prospectively updated database. Of the 82 patients identified, 61 (74%) received a letter or were otherwise contacted by telephone. Of these, 27 (44%) patients confirmed that they had access to the Internet. A total of 21 complete sets of data were collected. On review, the available secure online Oxford outcome scores demonstrated a mean of 30.1 (SD 11.4, range: 9-47). This mean score was comparable to the pen-and-paper database mean score of 29.1 (SD 11.8, range: 9-48) for the respective patients. Of the 27 respondents with Internet access, 21 (78%) produced complete scores that were available for real-time review. Available online scores were comparable to those collected via traditional means. With increased Internet availability and improved communication, remote web-based collection of patient reported outcomes may facilitate enhanced and efficient follow-up of patients.