Clinical and Radiological Comparison of Semirigid (WavefleX) and Rigid System for the Lumbar Spine.

OBJECTIVE: Spinal fusion operation is an effective treatment in the spinal pathology, but it could change the physiological distribution of load at the instrumented and adjacent segments. This retrospective study compared the radiological and clinical outcomes of patients undergoing lumbar fusion with semirigid rods versus rigid rods system. METHODS: Using transpedicular fixation and posterior lumbar interbody fusion at the level of L4/L5, 20 patients were treated with semirigid rods (WavefleX, SR group), and 20 patients with rigid rods (titanium, RR group). Clinical and radiological outcomes were evaluated, including visual analog score for lower back pain and leg pain, Prolo functional and economic scores, statues of implanted instruments, fusion rate, and complications during 24-month follow-up. RESULTS: Clinical scores were significantly improved until postoperative 24-month follow-up as compared with preoperative scores in both groups (p<0.05), with similar levels of improvement observed at the same time points postoperatively between the 2 groups. Prolo economic scores were significantly improved in SR group compared to RR until 12 months, but this improvement became similar after 18 months. The overall fusion rate was 94.1% until the 24-month follow-up for both groups. No significant complication was observed in both groups. CONCLUSION: The results of the present study indicate that semirigid rods system with posterior lumbar interbody fusion showed similar clinical and radiological result with rigid rods system until 2 years after instrumentation. The WavefleX rods system, as a semirigid rods with unique characteristics, may be an effective alternative treatment for patients in lumbar fusion.

The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine whether shoulder rotation increases the length of the posterior longitudinal ligament (PLL) in the lateral decubitus position. METHODS: Thirty-four adult male volunteers were placed in the right or left lateral decubitus and flexion position on a horizontal operating table. Thoracic spinal ultrasonography was performed using the paramedian oblique sagittal plane to obtain the optimal ultrasound view for the PLL on the dependent side. The lengths of the PLL were measured at the T6/7 and T9/10 interspaces before and after ipsilateral 30-degree shoulder rotation. RESULTS: In the right lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 7.4 (2.8) to 8.4 (2.6) mm (P = 0.006) at the T6/7 level and from 8.4 (2.9) to 10.6 (2.8) mm (P < 0.0001) at the T9/10 level. Similarly, in the left lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 8.0 (2.6) to 9.1 (2.6) mm (P = 0.001) at the T6/7 level and from 9.3 (2.8) to 11.8 (3.1) mm (P < 0.0001) at the T9/10 level. CONCLUSIONS: Shoulder rotation significantly increased the dimension of the acoustic target window for paramedian thoracic epidural access in the lateral decubitus position at both T6/7 and T9/10 levels. Further clinical studies are needed to investigate the effect of shoulder rotation on thoracic epidural access.

A comparison of QTc intervals following laryngoscopic intubation and i-gel insertion during propofol-sevoflurane anesthesia.

BACKGROUND: Laryngoscopic intubation and supraglottic airway device insertion can prolong the corrected QT (QTc) interval during anaesthetic induction even in healthy patients. No prior study has compared the effect of laryngoscopic intubation and supraglottic airway device, i-gel, insertion on the QTc interval change. METHODS: Patients were randomised to either the intubation group (N.=25) or the i-gel group (N.=25) before induction. The QT interval was sequentially measured in lead II following a standard anaesthetic technique for induction using propofol and sevoflurane. Four sequential QT values were applied to the Bazett's formula to correct for the effect of heart rate on the QT interval, and then averaged. The peak QTc interval, the duration of QTc prolongation >20 ms compared to the QTc value immediately before intubation or i-gel insertion and the incidence of the QTc intervals >500 ms were measured. RESULTS: The peak QTc interval was lower in i-gel group (458.4±24.3 ms) than in intubation group (488.6±32.6 ms) (P=0.001). The duration of QTc prolongation >20 ms compared to the QTc values at immediately before intubation or i-gel insertion was significantly longer in the intubation group (136.5±104.5 s) than that of the i-gel group (56.9±56.5 s) (P=0.031). The number of patients with QTc interval >500 ms was significantly lower in the i-gel group (4%) than in the intubation group (48%). CONCLUSIONS: The insertion of the i-gel produces less QTc interval change than laryngoscopic intubation. The i-gel may be advantageous to patients who are at risk of QTc prolongation, high blood pressure and tachycardia.