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PubMed1999

Visceral and vascular complications resulting from anterior lumbar interbody fusion.

OBJECT: The literature on abdominal and general surgery-related complications following anterior lumbar interbody fusion (ALIF) is scant. In this retrospective review of 60 patients in whom ALIF was performed at their institutions between 1996 and 1998, the authors detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also discussed. METHODS: The study group was composed of 31 men and 29 women whose mean age was 42 years (range 29-71 years). The preoperative diagnosis was discogenic back pain in 33 patients (55%); failed back syndrome in 11 (18.3%); pseudarthrosis in five (8.3%); postlaminectomy syndrome in four (6.6%); spondylolisthesis in three (5%); burst fracture in two (3.3%); and malignancy in two (3.3%). A retroperitoneal approach to the spine was used in 57 of the 60 patients. One interspace was exposed in 28 patients (46.6%), two in 28 (46.6%), and three in four (6.6%). Discectomy and interbody fusion in which the authors placed titanium cages or bone dowels was performed in 56 patients and corpectomy with instrumentation in four. Seven (11.6%) of 60 patients had undergone previous abdominal surgery and 29 (48.3%) had undergone previous spinal surgery. The follow-up period averaged 12+/-4 months (mean+/-standard deviation). Twenty-four general surgery-related complications occurred in 23 patients (38.3%), including sympathetic dysfunction in six; vascular injury in four; somatic neural injury in three; sexual dysfunction in three; prolonged ileus in three; wound incompetence in two; and deep venous thrombosis, acute pancreatitis, and bowel injury in one patient each. There were no deaths. The incidence of complications was not associated with underlying diagnosis (p>0.1), age (p>0.5), previous abdominal or spinal surgery (p>0.1), or the number of levels exposed (p>0.1). CONCLUSIONS: This report provides a detailed analysis of the general surgery-related complications following ALIF. Although many of these complications have been recognized in the literature, the significance of sympathetic dysfunction appears to have been underestimated. The high incidence of complications in this series likely reflects the strict criteria. Many of these complications were minor and resolved over time without long-term sequelae.

Adult↗

PubMed2000

Complications of posterior lumbar interbody fusion when using a titanium threaded cage device.

OBJECT: The authors reviewed their series of patients to quantify clinical and radiographic complications in those who underwent a posterior lumbar interbody fusion (PLIF) procedure in which a threaded interbody cage (TIC) was implanted. METHODS: Sixty-seven patients underwent a posterior lumbar interbody fusion procedure in which a TIC was used. The authors excluded patients who underwent procedures in which other instrumentation was used or a nondorsal approach was performed. Fifteen percent of the cases (10 patients) were complicated by laceration of the dura. In three cases, bilateral implantation could not be performed. The average blood loss was 670 ml for all cases, and blood transfusion was required in 25% of the cases (17 patients). The rate of minor wound complication was 4.5% (three patients). One patient died. The average period of hospitalization was 4.25 days. Twenty-eight patients (42%) experienced significant low-back pain 3 months postoperatively, and in 10 (15%) of these cases it persisted beyond 1 year. In 10 patients postoperative radiculopathy was demonstrated, and magnetic resonance imaging revealed epidural fibrosis in six patients, arachnoiditis in one, and a recurrent disc herniation in one. One patient incurred a permanent motor deficit with sexual dysfunction. Pseudarthrosis was suggested radiographically with evidence of motion on lateral flexion-extension radiographs (10 cases), lucencies around the implants (seven cases), and posterior migration of the cage (two cases). Additional procedures (in 14 patients) consisted primarily of transverse process fusion with pedicle screw and plate augmentation for persistent back pain and radiographically demonstrated signs of spinal instability. In two patients with radiculopathy, migration of the TIC required that it be removed. Graft material that extruded from one implant necessitated its removal. In one patient scarectomy was performed. CONCLUSIONS: Our high incidence of TIC-related complications in PLIF is inconsistent with that reported in previous studies.

Adolescent↗

PubMed1985

Salah Eddin external fixation system: a bone slider and compressor.

This study involves 65 patients with severe war injuries to the extremities where all conventional and available lines of treatment have failed or a decision of amputation has been made. Twelve humeri, 45 tibiae and eight femura were studied. The sliding system was used on 39 patients and the compressor system on 26 patients. In the sliding system, gaps ranged from 2 cm to 12 cm. In the compressor system established nonunion, failed bone graft operations, infected pseudarthrosis and gaps less than 2 cm were studied. Salah Eddin external fixation systems, both sliding and compressor, were found to be efficient, biomechanically adequate, easy to apply and remove and able to replace considerable gaps with no risks of open surgery.

Adult↗

PubMed1997

Freeze-dried cortical allograft in posterior spinal arthrodesis: use with segmental instrumentation for idiopathic adolescent scoliosis.

Many surgeons use cancellous or corticocancellous allogeneic bone grafts to augment spinal arthrodeses. The efficacy of onlay freeze-dried cortical allografts for posterior spinal fusions has been questioned in the past. In this report, freeze-dried, crushed cortical bone allograft was used as the sole fusion material in 32 consecutive posterior spinal fusions for idiopathic adolescent scoliosis. Absence of clinical or radiographic pseudarthrosis in all patients at an average follow up of 34 months suggests that freeze-dried, crushed cortical bone allograft is a suitable material for augmentation of the fusion mass during posterior spinal fusion with segmental instrumentation.

Adolescent↗

PubMed1999

Pediatric vertebral and spinal cord tumors: a retrospective study of musculoskeletal aspects of presentation, treatment, and complications.

Fifty-two pediatric patients with documented vertebral and spinal cord tumors were reviewed to evaluate the musculoskeletal manifestations of presentation, treatment, and management of complications. Diagnoses included 16 malignant and 36 nonmalignant vertebral and spinal cord tumors. Mean age at diagnosis was 8 years 1 month, and the male-to-female ratio was 1.7:1. Overall, there was an average delay in diagnosis of 12 months for this group of patients. Mean clinical follow-up was 5 years. The two most common reasons for presentation were pain (67%) and spinal deformity (46%). Initial plain radiographs were positive in 82% of patients. Postlaminectomy spinal deformity occurred at a rate of 45% in patients undergoing laminectomies, and 60% of those with deformity required spinal fusion. Overall, 67% of the 52 patients underwent spinal fusion, with a 9% asymptomatic pseudarthrosis rate. Complications were common, with 1.9 complications per patient; 59% of complications required surgical management. There were no perioperative deaths. At follow-up, 19% of patients had neurologic deficits ranging from neurogenic bladder to lower extremity weakness and difficulty walking to quadriplegic. Eighty-six percent of patients were ambulating without difficulty at follow-up. The survival rate was 94% and the local recurrence rate was 27% at most recent follow-up.

Adolescent↗

PubMedDate not supplied

Free vascularized fibular grafts for reconstruction of skeletal defects.

Nourished by the peroneal vessels, the versatile free vascularized fibular graft can be transferred to reconstruct skeletal defects of the extremities. It may be combined with skin, fascia, muscle, and growth-plate tissue to address the needs of the recipient site. It may be cut transversely and folded to reconstruct the length and width of tibial or femoral defects. The main indications for this graft are defects larger than 5 to 6 cm or with poor vascularity of the surrounding soft tissues. Detailed preoperative planning, experience in microvascular techniques, and careful postoperative follow-up are necessary to minimize complications and improve outcome. The free vascularized fibular graft has been successfully applied as a reconstruction option in patients with traumatic or septic skeletal defect, after tumor resection, and has shown promise in patients with congenital pseudarthrosis.

Bone Neoplasms↗

PubMed1976

[Treatment of undesirable results following operations on the proximal end of the femur in children (author's transl)].

The initial results following operations on the proximal end of the femur in children may not be permanent. They are frequently altered by further growth of the bone. This influence of growth on the operative result cannot always be predicted. The author reports 6 cases with poor results following operations on the proximal end of the femus. In 3 children varus-rotation osteotomies resulted in pseudarthrosis and/or severe angulation. Resection of a solitary bone cyst and operative treatment of fractures of the proximal femur in 2 other cases produced similar complications. Treatment of these undesirable results consisted of osteotomy with correction in all 3 dimensions and medial displacement of the shaft under the neck of the femur. Fixation of the fragments was obtained with traction-bracing according to Pauwels. The early results were good in all cases. The author concludes that an operation on the proximal end of the femur in children is indicated only when absolutely necessary and when it is fairly certain that growth cannot alter the results unfavorably. Only those procedures should be recommended which have been shown to give satisfactory results in an adequate number of cases that remain unaltered throughout the entire growth period.

Adolescent↗

PubMed1994

Prognostic factors in lumbar spinal fusion.

The charts of 234 patients who underwent 260 spinal fusions for degenerative spinal disease were reviewed to determine prognostic factors for predicting successful surgical outcome. All patients were evaluated for fusion success and symptomatic relief. Pseudarthrosis occurred in 26 patients (10%) and 14 others failed to have symptomatic improvement despite successful fusion. Outcome was found to be significantly related to smoking status, diagnosis, use of hardware, insurance status, preoperative SGPT level, prior operations or decompressions, and age. The relative risk associated with smoking was 2.9. The association with smoking was present for both subjective and objective poor outcomes. A predictive function based on smoking status and diagnosis was developed. Ninety-two percent of nonsmokers with favorable diagnoses had a good outcome, compared to 77% of those with unfavorable diagnoses. The percentages for the comparable groups of smokers were 77% and 54%.

Adolescent↗

PubMed1999

[Intercarpal and radiocarpal resection arthroplasty and arthrodesis].

Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBOCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis. Implant resection arthroplasty of the lunate and scaphoid or total wrist implants are still causing multiple problems regarding heavy load. Therefore this implants should be confined to rheumatoid patients. Of the limited carpal arthrodeses the scaphotrapezium-trapezoid arthrodeses is the most frequent performed procedure. It can be indicated for STT-osteoarthritis, KIEHNBOCK's disease, scapho-lunate instability and scaphoid pseudarthrosis if other surgical procedures had failed presuming there are no signs of arthrosis in the radiocarpal joint. Persisting pain especially in heavy work is quite frequent after limited arthrodesis but can be greatly relieved by simultaneous wrist denervation. In advanced cases of osteoarthritis total wrist arthrodesis is still the best choice for the patient.

Arthritis, Rheumatoid↗

PubMed2000

[Tibialization of the fibula for a large bone loss. A case report].

A 10-centimeter tibial bone loss was treated by inter-tibiofibular bone grafting on each part of the pseudarthrosis, resulting in tibialization of the fibula. The patient was reviewed after 10 years; the clinical result was satisfactory and stable. The tibial forces were deviated on the fibula, which expressed radiologically by important thickening of its cortices. This case illustrates the interest of preserving the fibula for tibial bone loss reconstruction.

Adult↗

PubMed1998

[Treatment of humeral fractures by Marchetti nailing. Apropos of 45 cases].

Between 1995 and 1997 we implanted 45 Marchetti nails. These nails were implanted for traumatic fractures in 39 patients, but also for pathologic fractures in 5 patients. Among these 39 patients, 7 were lost of view, the average age was 60 years. Among these 39 patients, 4 have got an other treatment before which failed. 10 fractures were placed D1, 8 fractures placed D2, 5 fractures placed D3, 16 fractures placed D4 according to the classification of Hackethal modified by De la Caffinière. The fracture type was classified according to A. O. classification: 7 A1, 11 A2, 7 A3, 2 B1, 6 B2, 1 B3, 4 C1, 1 C2. Among the 32 patients reviewed with an average of follow-up of 11 months, we have observed 5 very good results, 14 good results, 6 passable results and 3 bad results (classification of Stewart and Hundley). The average length of consolidation was 3 months. At follow-up the average elbow mobility was 129 degrees. Among the 3 bad results, there were 2 pseudarthrosis, in D4 zone. We have got 3 supracondylar fractures during the removal of the nail and 2 impactions of the metaphysis fracture. 5 patients had a nailing for pathologic fractures, one of them bilateral (4 women and one man, average age 65 years). Only two patients were reviewed, the fracture healed without any difference with the traumatic group. Contrary to other nailing, this materiel respects the rotator cuff. The global functional result was good.

Adolescent↗

PubMed1975

[Results of bone homoplasty in ununited fractures, pseudarthroses and defects of the long tumular bones].

In the article, observations on application of bone homoplasty in 99 patients with unhealing fractures, pseudarthrosis and defects of long tumular bones are described. Homoplasty per se was performed in 22 cases, in combination with autoplasty--in 3, with metallic osteosynthesis--in 74. Tubular homografts were used in 14 cases, grafts in a kind of cortical plates--in 85. Postoperatively, the patients were followed within the terms up to 5 years. In 88 cases the results of surgery were satisfactory, in 11--poor. An analysis of the material concerned have shown that issues of bone homoplasty are greatly effected by the character of the graft, surgical technic and the state of a recipient bed.

Adult↗

PubMed1975

Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital.

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.

Braces↗

PubMed2001

Conversion of hip arthrodesis to total hip arthroplasty.

With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the rates of revision after converting an arthrodesed hip to a THA are quite high. The procedure can be complex. Consideration should be given to referring these patients to a specialized center under the care of an experienced arthroplasty surgeon if preoperative planning suggests that the conversion will not be straightforward.

Adult↗

PubMed1975

Results of Harrington instrumentation and fusion in the adult idiopathic scoliosis patient.

Between January 1961 and December 1972, 132 patients over twenty years old with idiopathic scoliosis were surgically treated using Harrington instrumentation and fusion techniques. All patients were seen by us because of curve magnitude or symptoms secondary to scoliosis. The average correction obtained at operation was 48 per cent. Twenty-four patients had early complications. Fifty-two had late complications, the most frequent of which was pseudarthrosis. The majority of patients had significant improvement in symptoms as a result of surgical correction and stabilization.

Adult↗

PubMed1975

[Complications in extrafocal compression and distraction for nonunion of the tibia].

While analysing the results of 118 operations for extrafocal compression, distraction and compression-distraction osteosynthesis with the G. A. Ilizarov apparatus in 116 patients showing nonunion of fractures and pseudarthrosis of the tibia, the author observed 53 various complications among 40 operations (33.9%). 78 operations were without any complications (66.1%). The greatest number of complications was noted while using a distraction method. Some recommendations on the treatment and prophylaxis of such complications are given.

Fracture Fixation↗

PubMed1976

Thoracolumbar scoliosis in cerebral palsy. Results of surgical treatment.

Of 294 patients with cerebral palsy seen from 1960 to 1972, forty-two had clinically significant lumbar and thoracolumbar scoliosis (31 to 135 degrees) and thirty-three were treated by spine surgery: ten by Harrington instrumentation and posterior spine fusion, eighteen by the Dwyer procedure and anterior fusion, and five by a two-stage combined anterior and posterior fusion. Evaluation of the results after eighteen to sixty-eight months showed: relief of pain in seventeen cases, improved sitting tolerance in seventeen, less nursing care needed in three, less equipment required in six, ability to use equipment providing more function in three, placement in a facility where less care was required in two, and improved eating patterns in two. Only the combined procedure appeared to give adequate correction and a low incidence of pseudarthrosis.

Adolescent↗

PubMed1976

The postoperative management of scoliosis patients treated with Harrington instrumentation and fusion.

A retrospective study of maintenance of correction as affected by modifications in the management of patients surgically treated for scoliosis showed better results in Group B than in Group A. No supplementary bone was used in the 187 patients in Group A, who were maintained recumbent for three months postoperatively and who wore an underarm body cast for six months. The 177 patients in Group B received autogenous iliac-bone grafts, were allowed to walk seven to ten days postoperatively, and wore an underarm body cast for nine months. By two years postoperatively the patients in Group A had lost an average of 8.3 degrees of correction, and the patients in Group B had lost 4.3 degrees. A pseudarthrosis developed in eight patients in Group A and in one patient in Group B.

Adolescent↗