Radiographic evaluation of posterolateral lumbar fusion for degenerative spondylolisthesis: long-term follow-up of more than 10 years vs. midterm follow-up of 2–5 years

Although posterolateral fusion of the lumbar spine without instrumentation has been widely performed for spinal instability caused by degenerative spondylolisthesis in the lumbar spine, few long-term follow-up studies have been reported. We studied ten patients who underwent posterolateral fusion for degenerative spondylolisthesis in the lumbar spine without instrumentation in our hospital, five of whom were followed up for more than 10 years and the other five for 2–5 years. We used radiography to examine their fusion status, instability and degenerative changes at the fusion level, change in the slip, change in lumbar lordosis, and instability and degenerative changes one level above and one level below the fusion. In most of the ten patients, radiographic evaluation demonstrated solid fusion, minimal degenerative changes, and preservation of lumbar lordosis and spinal mobility. Posterolateral lumbar fusion for degenerative spondylolisthesis in the lumbar spine seems promising for obtaining not only good radiographic features but also good clinical results lasting over more than 10 years. Electronic Publication     

Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11–13?years

Introduction and materials

We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; failed back syndrome after one to five discectomies; and failed back syndrome after one to three laminectomy operations (Groups 1–4, respectively).

Methods

They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated.

Results

The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1 %. The reoperation rate was 15.1 % (7.5 % due to adjacent segment disease).

Conclusion

Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0 %, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0 %. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for >80 % of patients, but varied among groups.     

Subjective impact of traumatic brain injury on long-term outcome at a minimum of 10 years after trauma– first results of a survey on 368 patients from a single academic trauma center in Germany

Background

Traumatic Brain Injury (TBI) may lead to significant impairments in personal, social and professional life. However, knowledge of the influence on long-term outcome after TBI is sparse. We therefore aimed to investigate the subjective effects of TBI on long-term outcome at a minimum of 10 years after trauma in one of the largest study populations in Germany.

Methods

The current investigation represents a retrospective cohort study at a level I trauma center including physical examination or standardized questionnaires of patients with mild, moderate or severe isolated TBI with a minimum follow-up of 10 years. We investigated the subjective physical, psychological and social outcome evaluating the Glasgow Outcome Scale, short-form 12, and social as well as vocational living circumstances.

Results

368 patients aged 0 to 88 years were included. Patients with severe TBI were younger compared to patients with moderate or mild TBI (p?<?0.05). Patients with severe TBI lived more often as single after the trauma impact. A significantly worse outcome was associated with higher severity of TBI resulting in an increased incidence of mental disability. A professional decline was analyzed in case of severe TBI resulting in significant loss of salary.

Conclusions

The severity of TBI significantly influenced the subjective social and living conditions. Subjective mental and physical outcome as well as professional life depended on the severity of TBI 10 years after the injury.

     

Long-term prognosis of nerve palsy after total hip arthroplasty: results of two-year-follow-ups and long-term results after a mean time of 8 years

Introduction

Nerve damage is a rare but serious complication after THA. There exist only little data about the outcome of these patients particularly regarding the long-term results later than 2 years postoperatively. Aim of this study is to answer the following questions: Is the recovery to be expected for light nerve lesions different from the severe ones? Is there a possibility of nerve recovery more than 2 years after THA? Is the potential of nerve recovery depending on the affected nerve?

Materials and methods

This study investigates 2,255 primary THA as well as revision surgeries performed from 1988 to 2003 relating to iatrogenic nerve lesion. We classified the nerve lesion according to the core muscle strength in severe (M0–M2) and light (M3–M4) nerve damage and differentiated between femoral, sciatic and superior gluteal nerve, according to the electromyography.

Results

We found 34 cases of iatrogenic nerve damage representing an incidence of 1.5 %. 17 of 34 (50 %) patients showed a complete recovery after 2 years. Out of the remaining 17 patients, six out of seven patients with a final examination after a median time of 93 months achieved further improvement. The different nerves showed no significant different potential of recovery.

Conclusions

In contrast to the literature, an improvement beyond the limit of 2 years is probable and independent of the nerve affected.     

Endoscopic submucosal dissection versus surgical resection for early gastric cancer: a retrospective multicenter study on immediate and long-term outcome over 5 years

Background

Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection.

Method

We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008.

Result

ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups.

Conclusion

ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.

     

The natural clinical course of lumbar spinal stenosis: a longitudinal cohort study over a minimum of 10 years

Background

Little is known about the short- and long-term prognoses of conservative treatment of lumbar spinal stenosis (LSS). Furthermore, there are no reports in the literature that investigate the relationship between longitudinal imaging changes and clinical symptoms in patients with LSS. This longitudinal cohort study aimed to clarify the morphologic changes and role of conservative treatment in LSS.

Methods

This study included 34 patients with leg or low back pain who had received a diagnosis of LSS by magnetic resonance imaging (MRI). The patients’ average age was 58 years at the initial examination. All participants received conservative treatment with or without medication for over 10 years. The clinical course was assessed by using the Japanese Orthopaedic Association scoring system, a visual analog scale for back or leg pain, and symptomatic Johnsson’s classification. Additionally, patients’ dural sac cross-sectional area was measured on axial MRI.

Results

One patient could not be contacted and four others died during this investigation. After an average follow-up of 11.1 years, symptoms improved in approximately 30 % of patients, remained unchanged in 30 %, and worsened in 30 %. The dural sac cross-sectional areas in both the worsened and unchanged groups were significantly smaller than that of the improved group (P < 0.05). In the worsened group, the average area at the initial examination was <50 mm². Some patients underwent surgery during this observation, and had severe narrowing (<40 mm²) of the area at the initial examination.

Conclusions

This study showed that clinical symptoms of LSS did not develop in more than 60 % of patients who received conservative treatment, which was dependent on the severity of LSS. In patients with severe LSS and a dural sac cross-sectional area <50 mm², the clinical course may deteriorate with conservative treatment, and surgery should be considered at an early stage.     

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups. This work is dedicated to the memory of Grace and Julia Hanson.     

Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years

Background  

Gastric band erosion is a well-reported complication after laparoscopic adjustable gastric banding (LAGB). The published literature is limited and inconclusive with regard to its management. The authors therefore reviewed all band erosions detected during a 5-year period in a high-volume bariatric practice. Because a significant proportion of the band insertions (65%) were undertaken by an operator beyond his learning curve, the authors hoped to gain a mature, comprehensive understanding of this significant complication.     

Favourable long-term clinical outcome after anterior cervical discectomy. A study on a series of 125 patients undergoing surgery a mean of 11 years earlier

Objective

This retrospective study assessed long-term clinical outcome in a series of patients undergoing anterior cervical discectomy (ACD) for treatment of myeloradiculopathy secondary to one- to two-level cervical discoarthrosis. To verify concerns about long-term adverse clinical effects following ACD, a review of literature on the topic was also made.

Methods

The clinical course and long-term outcome of 125 consecutive patients with cervical myeloradiculopathy operated on by ACD 5 to 19 years ago (mean, 11.3 years) were reviewed. Seventy-four patients (59%) showed a clinical picture of pure radiculopathy, and 51 patients (41%) had myeloradiculopathy. Long-term clinical outcome and Visual Analog Scale (VAS) scores for neck and arm pain were recently assessed and compared with post-surgical status. Clinical outcome was graded according to the criteria of Odom et al. (JAMA 166:23–28, 36). The survey of the literature on long-term clinical outcome after ACD was internet-based.

Results

Long-term clinical outcome was excellent in 61% of patients, good in 26%, satisfactory in 9% and poor in 4%. The same figures at the time of discharge were 65%, 29%, 6% and 0%, respectively. Mean long-term neck and arm pain VAS scores were 2.5 and 0.8, respectively, while postoperatively, the same values were 2.1 and 0.5. Additional discectomy at an adjacent level was performed in five patients 10 months to 8 years after the first operation.

Conclusions

In our series, 96% of patients had a sustained favourable long-term clinical outcome after ACD. These favourable results confirm data in the literature and support our preference for ACD as the simplest, fastest and cheapest surgical option for treating myeloradiculopathy secondary to one- to two-level cervical discoarthrosis.     

Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years

Purpose

The aim of our study was to review the clinical and radiological outcome of patients who had undergone anterior cruciate ligament (ACL) reconstruction in comparison to a group of non-operatively treated patients.

Methods

In a retrospective study we compared ACL reconstruction using a bone-patellar tendon-bone graft with a non-operatively treated group of patients 17–20 years later. Fifty-four patients that met the inclusion criteria, with arthroscopically proven ACL rupture, were treated between 1989 and 1991. Thirty-three patients underwent ACL reconstruction, forming group one. Eighteen non-reconstructed patients continued with rehabilitation and modification of activities (group two). The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms and the Lysholm and Tegner scale were used to assess the knees at follow-up. Radiographic assessment was performed using the IKDC grading scale.

Results

Follow-up results showed that 83% of reconstructed patients had stable knees and normal or nearly normal IKDC grade. Patients in the non-reconstructed group had unstable knees with 84% having abnormal or severe laxity. The subjective IKDC score was significantly in favour of group one: 83.15 compared to 64.6 in group two. The Lysholm and Tegner score was also significantly better in group one. Conservatively treated patients all had unstable knees and worse scores. The rate of osteoarthritis showed more severe changes in non-reconstructed patients with additional meniscus injury.

Conclusions

We can conclude that 94% of patients who underwent ACL reconstruction had stable knees after 15–20 years and there was a significantly lower percentage of osteoarthritis in comparison to conservatively treated patients.     

Legg-Calvé-Perthes disease in patients under 5 years of age does not always result in a good outcome. Personal experience and meta-analysis of the literature

This study attempted to analyze objectively the long-standing impression that children under 5 years of age, who have Legg-Calvé-Perthes disease, generally do well. Thirty patients, with 36 hips and onset of disease prior to their fifth birthday were reviewed at skeletal maturity. More than 50% of the hips were classified in Catterall group 3 or 4, and Herring group C. The end evaluation by the Stulberg classification showed 44.5% good, 22.2% fair and 33.3% poor results. By the Mose rating the results were respectively 27.8% good, 30.6% fair and 41.6% poor.A meta-analysis of the literature showed a very broad spectrum of results, leading to the conclusion, first, that comparison is difficult and, second, that young age is not a free ticket to a good result.     

Clinical and radiographical results of 179 thrust plate hip prostheses: 5–14 years follow-up study

Introduction  

The thrust plate hip prosthesis (TPP) is a bone-reserving prosthesis for cementless fixation at the metaphysis of the proximal femur. We retrospectively evaluated the results of 162 patients (179 hips) who underwent hip arthroplasty using TPP.     

Necrotizing fasciitis of the extremities: 34 cases at a single centre over the past 5 years

Background  

Worldwide the incidence of necrotizing fasciitis (NF) is on the rise. This rapidly progressive infection is a true infectious disease emergency due to its high morbidity and mortality. The mainstay of therapy is prompt surgical debridement, intravenous antibiotics, and supportive care with fluid and electrolyte management. Because of its high mortality rate, patients are increasingly referred to burn centres for specialized wound and critical care issues.     

Management and outcomes of penile fracture: 10 years’ experience from a tertiary care center

Objectives

To evaluate our experience on diagnosis and management of penile fractures.

Materials and methods

This retrospective study included 31 patients who were treated for penile fracture between 2002 and 2012. We analyzed the etiology of penile fracture, concomitant pathologies such as urethral injury, deep or superficial dorsal vein ruptures, treatment modalities (surgery or conservative treatment) and complications of treatment modalities.

Results

The mean age of the patients was 32 years (range, 23–47 years). In 27 patients (87 %), the cause of penile fracture was sexual intercourse. Patients presented with swelling, pain and popping or cracking sound in penis. The diagnosis of penile fracture was established clinically in all of the patients. There were no urethral injuries or dorsal vein ruptures. Ten patients who refused surgical treatment were treated conservatively and remaining 21 patients with early surgical intervention. Among conservatively treated patients, two suffered from erectile dysfunction, two from painful erection and another two from penile curvature. No serious complications such as erectile dysfunction, penile curvature or painful erection were observed in surgically treated patients.

Conclusion

Penile fracture can be diagnosed easily with history and physical examination, and favorable functional results can be achieved with early surgical repair.     

Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years

Background

Prospective evaluation of atlanto-occipital dissociations (AODs) at a level 1 trauma centre within 5 years.

Methods

Over a period of 5 years (2005–2009), all CT scans of the skull base and the upper cervical spine due to traumatic injuries were prospectively entered into a database. Furthermore, in cases of confirmed AOD all empirical data were prospectively collected. A more detailed data analysis of all AOD patients was conducted 2 years post-trauma. If required, another prospective follow-up was performed.

Results

2,616 CT scans were performed in total. Out of these, there were five male patients with confirmed AOD. Thus, the total incidence was 0.2 %. AOD was associated with occipital condyle fractures in three out of the five cases. Three out of five patients (60 %) died due to the severity of the injury. It was possible to stabilise two patients surgically with a clinical/radiological follow-up 2 years post-surgery. At that time, one patient had an incomplete tetraplegia and was wheelchair ridden without needing ventilation, while the other patient suffered from post-traumatic stress disorder, but was able to walk and live alone.

Conclusions

AOD is a rarely seen injury, even in a level 1 trauma centre, and is associated with high morbidity and mortality. However, it is possible for adults to survive this severe occipito-cervical injury after surgical repair while maintaining the ability to walk. All the results and recommendations are still based on a low level of evidence, due to the low incidence of this injury.     

Segmental pedicle screws instrumentation and fusion to L5 for spinal deformity secondary to Duchenne muscular dystrophy: results with a minimum of 2 years follow-up

Background

Traditional treatment recommendations in the surgical treatment of scoliosis in Duchenne muscular dystrophy have included instrumentation and fusion to the sacrum/pelvis to correct pelvic obliquity and to restore the sitting balance of the trunk. However, caudal extent of instrumentation and fusion has remained a matter of considerable debate. This study was performed to determine the efficacy and safety of stopping segmental pedicle screw constructs at L5 in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD), with mild pelvic obliquity (<15°).

Materials and methods

From May 2005 to June 2007, a total of 22 consecutive patients underwent posterior spinal fusion and segmental pedicle screw instrumentation only to L5 for scoliosis secondary to DMD. A minimum 2-year follow-up was required for inclusion in this study. Assessment was performed clinically and with radiologic measurements. Radiologic measurements included the Cobb angles of the curves in the coronal plane, thoracic kyphosis and lumbar lordosis in the sagittal plane, and pelvic obliquity. The operating time, blood loss, and complications were evaluated.

Results

Twenty patients, aged 11–17, were enrolled. The average follow-up period was 35 months. Preoperative coronal curves averaged 70° (range: 51–85°), with a postoperative mean of 15° (range: 8–25°) and 17° (range: 9–27°) at the last follow-up. Pelvic obliquity improved from 13° (range: 7–15°) preoperatively to 5° (range: 3–8°) postoperatively and 6° (range: 3–9°) at the last follow-up. Good sagittal plane alignment was recreated and maintained. No loss of correction of scoliosis and pelvic obliquity was noted. The mean operating time was 271 min (range: 232–308 min). The mean intraoperative blood loss was 890 ml (range: 660–1260 ml). The mean total blood loss was 2100 ml (range: 1250–2880 ml).There was no major complication.

Conclusion

Segmental pedicle screw instrumentation and fusion to L5 is effective and safe in patients with scoliosis secondary to DMD without significant pelvic obliquity initially and long term, obviating the need for fixation to the sacrum/pelvis. There was no major complication.     

Vascular risk factors and their association to serum androgen levels in a population-based cohort of 75-year-old men over 5 years: results of the VITA study

Purpose  

In contrast to the high prevalence of late onset hypogonadism, little is known regarding correlates for low androgen levels in aging men.     

Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study

Background  

Superior labrum anterior posterior (SLAP) lesions are a well-defined cause of shoulder pain and disability and may occur in conjunction with rotator cuff tears. This study was designed to prospectively evaluate the minimum 2 year results of arthroscopic repair of type II SLAP lesions in patients over the age of 45 years with and without rotator cuff tears.