Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries.

By London Spine
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Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries.

Clin Neurol Neurosurg. 2015 May 11;135:41-45

Authors: Kukreja S, Kalakoti P, Ahmed O, Nanda A

Abstract
INTRODUCTION: Workers’ compensation patients are known to be associated with inferior outcomes following lumbar surgery. We investigated demographics and clinical characteristics between the reoperative and non-reoperative group of patients undergoing decompression-alone lumbar surgery (discectomy and/or laminectomy) for on-the-job injuries (OJI) at our institute, and evaluated its possible impact on the reoperation-free survival (RFS).
METHODS: A retrospective analysis of patients undergoing lumbar surgery for OJI between 2003 through 2010 by a single surgeon (A.N.) was performed. A comparison of baseline clinical and demographic parameters between the two groups was compared using Fisher’s exact test for the categorical variables and the independent t-test (2-tailed) for the continuous variables. Overall, RFS was presented in Kaplan-Meier curves and the RFS difference was compared using log-rank (Mantel-Cox) test. Cox proportional hazard model was used for the univariate and multivariate analysis and hazard ratios with 95% confidence intervals were reported.
RESULTS: About 92 patients with mean age 48.07±10.10 years and mean follow-up of 36.4 (range 24.3-66.0) months were included. About 38 (41.3%) patients underwent reoperation for failed decompression-alone procedures whereas the non-reoperative cohort comprises 54 (58.7%) patients. Female gender (p=0.015) and history of previous surgery (p=0.05) were associated with a higher chance of reoperation. Majority of the reoperations (20/38, 52.6%) were performed within the first 2 years, with a RFS at the end of 2 years being 78.3% (n=72) and 58.9% (n=53) at 5 years. Cox-regression analysis did not demonstrate any influence of patients and treatment-related factors on the RFS.
CONCLUSION: There is a substantial risk of redo surgeries following decompression-alone lumbar procedures for OJI. As patient and treatment-related factors did not influence the reoperation rates and RFS in this study, it appears that workman compensation status of patients is inherently associated with poor outcomes following spine surgeries.

PMID: 26025885 [PubMed – as supplied by publisher]

[COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

By London Spine

[COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Dec;29(12):1504-9

Authors: Sun X, Zeng R, Li G, Wei B, Hu Z, Lin H, Chen G, Chen S, Sun J

Abstract
OBJECTIVE: To compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis.
METHODS: Between May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree I or II) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done.
RESULTS: Primary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1 ± 1.6) days] was significantly shorter than that of open group [(7.2 ± 2.1) days] (t = 2.593, P = 0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53% ± 20.52% in minimally invasive group, and was 64.21% ± 30.21% in open group, showing no significant difference (t = 0.725, P = 0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P < 0.05) except PI (P > 0.05), but there was no significant difference between 2 groups (P > 0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P < 0.05).
CONCLUSION: Both minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.

PMID: 27044219 [PubMed – in process]

Spinal nociceptive transmission by mechanical stimulation of bone marrow.

By London Spine
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Spinal nociceptive transmission by mechanical stimulation of bone marrow.

Mol Pain. 2016;12:

Authors: Ishida T, Tanaka S, Sekiguchi T, Sugiyama D, Kawamata M

Abstract
BACKGROUND: Since bone marrow receives innervation from A-delta and C-fibers and since an increase in intramedullary pressure in bone marrow may induce acute pain in orthopedic patients during surgery and chronic pain in patients with bone marrow edema, skeletal pain may partly originate from bone marrow. Intraosseous lesions, such as osteomyelitis and bone cancer, are also known to produce cutaneous hypersensitivity, which might be referred pain from bone. However, little is known about pain perception in bone marrow and referred pain induced by bone disease. Thus, we carried out an in vivo electrophysiological study and behavioral study to determine whether increased intraosseous pressure of the femur induces acute pain and whether increased intraosseous pressure induces referred pain in the corresponding receptive fields of the skin.
RESULTS: Intraosseous balloon inflation caused spontaneous pain-related behavior and mechanical hyperalgesia and allodynia in the lumbosacral region. Single neuronal activities of spinal dorsal horn neurons were extracellularly isolated, and then evoked responses to non-noxious and noxious cutaneous stimuli and intraosseous balloon inflation were recorded. Ninety-four spinal dorsal horn neurons, which had somatic receptive fields at the lower back and thigh, were obtained. Sixty-two percent of the wide-dynamic-range neurons (24/39) and 86% of the high-threshold neurons (12/14) responded to intraosseous balloon inflation, while none of the low-threshold neurons (0/41) responded to intraosseous balloon inflation. Spinally administered morphine (1 µg) abolished balloon inflation-induced spontaneous pain-related behavior and mechanical hyperalgesia in awake rats and also suppressed evoked activities of wide-dynamic-range neurons to noxious cutaneous stimulation and intraosseous balloon inflation.
CONCLUSIONS: The results suggest that mechanical stimulation to bone marrow produces nociception, concomitantly producing its referred pain in the corresponding skin fields. These mechanisms might contribute to pain caused by skeletal diseases.

PMID: 27030710 [PubMed – indexed for MEDLINE]

[TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH].

By London Spine

[TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Mar;29(3):315-20

Authors: Zhang H, Chu Ge, Pan C, Huang J, Hu W, Aikemu-Kahaer

Abstract
OBJECTIVE: To investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.
METHODS: Between January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect.
RESULTS: The 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean,20.12% months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P < 0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P < 0.05) except the segmental kyphotic curves angle (P > 0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35% ± 0.07%, 65.08% ± 0.07%, and 72.26% ± 0.11%, respectively; loss of correction was (3.04 ± 1.17), (2.81 ± 0.93), and (0.75 ± 0.50) degrees, respectively.
CONCLUSION: For patients at the age of 9-14 years, wit the Risser sign between grade 0-3, and with the Cobb angles less than 60 degrees, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.

PMID: 26455197 [PubMed – in process]

Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury.

By London Spine
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Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury.

Arch Phys Med Rehabil. 2013 May;94(5):822-8

Authors: Chang YJ, Liang JN, Hsu MJ, Lien HY, Fang CY, Lin CH

Abstract
OBJECTIVE: To investigate the possibility of restoring the adapted spinal circuit after spinal cord injury (SCI) by means of long-term continuous passive motion (CPM) of the ankle joint.
DESIGN: Randomized controlled trial with repeated measures.
SETTING: Research laboratory in a general hospital.
PARTICIPANTS: Individuals with motor complete SCI (N=14) were recruited from a community.
INTERVENTION: CPM of the ankle joint for 1 hour a day, 5 days a week for 4 weeks.
MAIN OUTCOME MEASURES: Modified Ashworth Scale (MAS) scores for evaluation of spasticity and postactivation depression (PAD) were documented prior to and after intervention.
RESULTS: MAS scores improved after 4 weeks of CPM intervention, indicating a reduction in spasticity of the ankle joint. PAD was restored after 4 weeks of training.
CONCLUSIONS: Passive motion of the ankle joint alone was sufficient in reversing the adapted spinal circuit, and therefore indicates that spasticity after SCI could possibly be managed by CPM intervention. The results of this study support the use of the passive mode of robot-assisted therapy for humans with complete SCI who cannot exercise actively.

PMID: 23219613 [PubMed – indexed for MEDLINE]

An unusual pain in the neck.

By London Spine

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An unusual pain in the neck.
Clin Infect Dis. 2014 Jun;58(11):1577-8; 1638-9
Authors: Trubiano JA, Slavin MA, Teh BW, Reed C, Worth LJ, Thursky KA
PMID: 24821696 [PubMed – indexed for MEDLIN…

[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis].

By London Spine
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[Extrapulmonary and extraspinal presentation of osteoarticular tuberculosis].

Acta Ortop Mex. 2012 Jan-Feb;26(1):15-20

Authors: Aparicio G, Viudez I, Pérez JL, Delgado F

Abstract
BACKGROUND: How to overcome the difficulty in diagnosing extrapulmonary and extraspinal osteoarticular tuberculosis? What is the most appropriate way to manage the patient?
MATERIAL AND METHODS: Retrospective series of four cases of extrapulmonary and extraspinal osteoarticular tuberculosis (two patients with knee involvement, one patient with involvement of the carpus, and a fourth patient who presented with tenosynovitis of the anterior tibial tendon of the ankle). The time elapsed from the onset of the clinical picture to the diagnosis ranged between 7 months and 2 years. The definitive diagnosis resulted from the presence of caseating granulomas in the biopsy (3 cases), and the isolation of the bacillus in culture (3 cases) or with staining (one case). Only in one case was there lung involvement after the extrapulmonary presentation. One patient had spinal involvement in the form of epidural abscess months after the extraspinal presentation. All patients received chemotherapy. Surgery was performed in 3 of the 4 cases. The Martini assessment was used to evaluate the functional outcome.
RESULTS: In all patients the lesion was cured, with two excellent and two poor functional outcomes.
CONCLUSIONS: A high clinical suspicion index is needed to prevent a delayed diagnosis. Chemotherapy is the cornerstone of treatment. Surgery is indicated mainly as a diagnostic procedure, but partial resection of the lesion may be performed at the same time.

PMID: 23320335 [PubMed – indexed for MEDLINE]