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1.
Purpose
The outcome of surgery for degenerative lumbar scoliosis was studied in the Swedish Spine register.Methods
209 patients (mean age 66 years) were identified; 45 had undergone decompression and/or fusion of one segment (minor group) and 164 had undergone fusion of two or more segments, with or without decompression (major group).Results
VAS back pain, VAS leg pain, ODI and EQ-5D index improved after surgery in both groups (p < 0.05), with medium to large effect sizes of surgery. Global assessment for back pain and satisfaction was significantly better in the major group than in the minor group (p < 0.05) at the 2-year follow-up. Additional spine surgery was observed in 57 out of the 209 patients during a mean period of 5.4 years.Conclusion
Surgery for degenerative lumbar scoliosis improves quality of life with medium to large effect sizes, but carries a high risk of additional surgery.2.
Yang Yang Liangming Zhang Bin Liu Mao Pang Peigen Xie Zihao Chen Wenbin Wu Feng Feng Limin Rong 《Journal of orthopaedics and traumatology》2017,18(4):395-400
Background
Hidden haemorrhage has been proved to be significant in joint surgery. However, when referring to lumbar interbody fusion, it is often ignored because of its invisibility. This randomized controlled study aimed to calculate and compare hidden haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion (MIS-TLIF and open TLIF). Meanwhile, its clinical significance was also analyzed.Materials and methods
A total of 41 patients were included in this study, then they were randomized to receive MIS-TLIF or open TLIF, 21 and 20, respectively. For each case, total volume loss of red blood cell (RBC) was calculated by Gross' formula based on perioperative haematocrit change, then perioperative visible volume loss of RBC was calculated through haemorrhage volume and weight. After deducting it from total volume loss of RBC, hidden volume loss of RBC was obtained. Absolute amount of hidden haemorrhage and its ratio upon total haemorrhage, as well as indicators assessing clinical outcomes, including visual analogue scale (VAS) for back and leg, Oswestry disability index (ODI), interbody fusion rate and complication incidence were compared and analyzed.Results
Mean hidden volume loss of RBC in MIS-TLIF was significantly reduced compared with open TLIF (166.7 versus 245.6 ml). Besides, both mean total and visible volume loss of RBC in MIS-TLIF were also statistically less than those in open TLIF (355.3 versus 538.6 ml; 188.6 versus 293.0 ml). While mean ratio of hidden haemorrhage upon total haemorrhage was 46.7% for MIS-TLIF and 44.5% for open TLIF, respectively, showing no statistical significance. At one week postoperatively, more significant improvements of VAS for back and leg, as well as ODI were seen in MIS-TLIF compared with open TLIF. While at final follow-up of at least 2 years, all parameters continued to improve and revealed no statistical difference between both surgeries. Similar interbody fusion rate and complication incidence were observed in both series.Conclusions
Besides reduced visible haemorrhage and improved clinical outcomes, MIS-TLIF also owns the superiority of less hidden haemorrhage, offering another advantage over open TLIF.Level of evidence
Level II.3.
Baioni Andrea Di Silvestre Mario Greggi Tiziana Vommaro Francesco Lolli Francesco Scarale Antonio 《European spine journal》2015,24(7):855-864
Purpose
Medium- to long-term retrospective evaluation of clinical and radiographic outcome in the treatment of degenerative lumbar diseases with hybrid posterior fixation.Methods
Thirty patients were included with the mean age of 47.8 years (range 35 to 60 years). All patients underwent posterior lumbar instrumentation using hybrid fixation for lumbar stenosis with instability (13 cases), degenerative spondylolisthesis Meyerding grade I (6 cases), degenerative disc disease of one or more adjacent levels in six cases and mild lumbar degenerative scoliosis in five patients. Clinical outcomes were evaluated using Oswestry disability index (ODI), Roland and Morris disability questionnaire (RMDQ), and the visual analog scale (VAS) pain scores. All patients were assessed by preoperative, postoperative and follow-up standing plain radiographs and lateral X-rays with flexion and extension. Adjacent disc degeneration was also evaluated by magnetic resonance imaging (MRI) at follow-up.Results
At a mean follow-up of 6.1 years, we observed on X-rays and/or MRI 3 cases of adjacent segment disease (10.0 %): two of them (6.6 %) presented symptoms and recurred a new surgery. The last patient (3.3 %) developed asymptomatic retrolisthesis of L3 not requiring revision surgery. The mean preoperative ODI score was 67.6, RMDQ score was 15.1, VAS back pain score was 9.5, and VAS leg pain score was 8.6. Postoperatively, these values improved to 28.1, 5.4, 3.1, and 2.9, respectively, and remained substantially unchanged at the final follow-up: (27.7, 5.2, 2.9, and 2.7, respectively).Conclusions
After 5-year follow-up, hybrid posterior lumbar fixation presented satisfying clinical outcomes in the treatment of degenerative disease.4.
Purpose
Lumbar spinal stenosis in the presence of degenerative spondylolisthesis is generally treated by means of surgery. The role of lumbar decompression without fusion is not clear. Therefore, the aim of this study was to assess whether patients who undergo decompression alone have a favourable outcome without the need for a subsequent fusion.Methods
This is a prospective cohort study with single blinding of 83 consecutive patients with lumbar stenosis and degenerative spondylolisthesis treated by decompression, without fusion, using a spinous process osteotomy. Blinded observers collected pre- and post-operative Oswestry Disability Index (ODI), EuroQol Five Dimensions (EQ-5D), and visual analogue scale (VAS) for back and leg pain scores prospectively. Failures for this study were those patients who required a subsequent lumbar fusion procedure at the decompressed levels. Statistical analysis was performed using paired t test and Mann–Whitney test.Results
There were 36 males and 47 females with a mean age of 66 years (range 35–82). The mean follow-up was 36 months (range 19–48 months). The mean pre-operative ODI, EQ-5D, and VAS scores were 52 [standard deviation (SD) 18], 0.25 (SD 0.30), and 61 (SD 22), respectively. All mean scores improved post-operatively to 38 (SD 23), 0.54 (SD 0.34) and 36 (SD 27), respectively. There was a statistically significant improvement in all scores (p ≤ 0.0001). Nine patients (11 %) required a subsequent fusion procedure and five patients (6 %) required revision decompression surgery alone.Conclusion
Our study’s results show that a lumbar decompression procedure without arthrodesis in a consecutive cohort of patients with lumbar spinal stenosis with degenerative spondylolisthesis had a significant post-operative improvement in ODI, EQ-5D, and VAS. The rate of post-operative instability and subsequent fusion is not high. Only one in 10 patients in this group ended up needing a subsequent fusion at a mean follow-up of 36 months, indicating that fusion is not always necessary in these patients.5.
Qi Wang Jun Liu Ying Shi Yu Chen Hailong Yu Junxiong Ma Weijian Ren Huifeng Yang Hongwei Wang Liangbi Xiang 《European spine journal》2016,25(5):1409-1416
Purpose
To determine the safety and short-term curative effects of internal fixation using a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation (ms-LDH) with the control group treated by posterior lumbar interbody fusion (PLIF).Methods
Forty-five patients with ms-LDH were selected as study group treated with Dynesys and 40 patients as control group with PLIF. The surgical efficacy was evaluated by comparing the visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI) scores and the ROMs of the adjacent segment before and after surgery. The postoperative complications related to the implants were identified.Results
All patients were followed up for an average duration of over 30 months. Dynesys stabilization resulted in significantly higher preservation of motion at the index level (p < 0.001), and significantly less (p < 0.05) hypermobility at the adjacent segments. VAS for back and leg pain and ODI improved significantly (p < 0.05) with both the methods, but there was no significant difference between the groups.Conclusions
The non-fusion fixation system Dynesys is safe and effective regarding short-term curative effects for the treatment of ms-LDH.6.
Tommi Kääriäinen Simo Taimela Timo Aalto Heikki Kröger Arto Herno Veli Turunen Sakari Savolainen Markku Kankaanpää Olavi Airaksinen Ville Leinonen 《European spine journal》2016,25(3):789-794
Purpose
Chronic low back pain and lumbar spinal stenosis (LSS) seem to deteriorate lumbar muscle function and proprioception but the effect of surgery on them remains unclear. This study evaluates the effect of decompressive surgery on lumbar movement perception and paraspinal and biceps brachii (BB) muscle responses during sudden upper limb loading in LSS.Methods
Low back and radicular pain intensity (VAS) and Oswestry Disability Index (ODI) were measured together with lumbar proprioception and paraspinal and BB muscle responses prior to and 3 and 24 months after surgery in 30 LSS patients. Lumbar proprioception was assessed by a previously validated motorized trunk rotation unit and muscle responses for sudden upper limb loading by surface EMG.Results
Lumbar perception threshold improved after surgery during 3-month follow-up (from 4.6° to 3.1°, P = 0.015) but tend to deteriorate again during 24 months (4.0°, P = 0.227). Preparatory paraspinal and BB muscle responses prior to sudden load as well as paraspinal muscle activation latencies after the load remained unchanged.Conclusion
Impaired lumbar proprioception seems to improve shortly after decompressive surgery but tends to deteriorate again with longer follow-up despite the sustaining favorable clinical outcome. The surgery did not affect either the feed-forward or the feed-back muscle function, which indicates that the abnormal muscle activity in LSS is at least partly irreversible.7.
Purpose
To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.Methods
An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.Results
Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = ?151.01 (?288.22, ?13.80), P = 0.03], shorter length of hospital stay [WMD = ?69.33 (?110.39, ?28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].Conclusions
Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.8.
Mihai Mardare Manuel Oprea Iulian Popa Ancuța Zazgyva Marius Niculescu Dan V. Poenaru 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(7):735-743
Purpose
Spinopelvic parameters can be useful in identifying risk factors for lumbar degenerative disc disease, but few studies assess patients with single-level disc herniation and most do not evaluate symptoms. This comparative retrospective study was aimed to analyse spinopelvic parameters, symptoms and MRI changes in patients with single-level lumbar disc herniation undergoing conservative or surgical treatment.Methods
Patients with clinical and radiological assessment (Japanese Orthopaedic Association Score) and an MRI evaluation of the lumbar spine were identified and divided into two groups: surgically treated (group A) and not requiring surgery (group B). Spinopelvic parameters were determined on standing profile radiographs of the lumbar spine and pelvis, and mean values were compared to those reported in the literature for normal subjects. MRI findings were graded according to the system described by Pfirrmann et al.Results
The study included 71 patients with single-level lumbar disc herniation: 26 in group A (39.4 ± 12.1 years) and 45 in group B (51.4 ± 17.2 years). The notable differences in spinopelvic parameter means between the two groups did not reach statistical significance. A positive correlations of age with pelvic tilt and Pfirrmann changes with pelvic incidence was only found in group A, while both groups showed highly significant positive correlations of pelvic incidence with the spine’s conformational type (p = 0.001).Conclusions
Characteristic changes in spinopelvic parameters identified in patients with lumbar degenerative disc disease were a reduction in pelvic incidence, sacral slope and lumbar lordosis, with an increased pelvic tilt. These were found to correlate with MRI changes in surgically treated patients.9.
Purpose
A bipolar sealer using Transcollation® technology, a combination of radiofrequency energy and saline, can provide hemostasis at 100 °C, which is lower than that used in standard electrocautery. Previous studies of joint arthroplasty have shown that use of the bipolar sealer reduces blood loss and tissue damage during the operation. However, it is unknown whether a bipolar sealer reduces blood loss and tissue damage in lumbar posterolateral fusion (PLF) surgery. The purpose of this study was to analyze the efficacy of this device in limiting blood loss during exposure of the lumbar spine in the treatment of PLF and postoperative pain.Methods
Fifty patients who underwent PLF were prospectively enrolled between October 2011 and March 2013. Twenty-five patients were randomized to the bipolar sealer group (BS group) and 25 patients to the standard electrocautery group (control group). Operative time and blood loss during exposure of posterior bony elements including the transverse process for PLF, visual analog scale (VAS) to quantify postoperative pain, and the interval from the surgery to hospital discharge were compared.Results
Operative time and blood loss expressed per level of exposure were significantly lower in the BS group than in the control group. There was a tendency toward a lower VAS at postoperative week 1 in the BS group. The duration of hospitalization was 15 and 26 days in the BS and control groups, respectively.Conclusions
A large randomized control trial adjusted for the number of fusion levels and body mass index is required to confirm the novelty value of this new bipolar sealers.10.
Purpose
Surgery for lumbar disc herniation (LDH) is most often elective, but intense pain may require more urgent, non-elective, treatment. It was hypothesized that non-elective treatment could be associated with a less favourable outcome than elective surgery. The aim of this study was to compare 1–2-year outcome after non-elective and elective surgery for treatment of para-median LDH using data from the Swedish Spine register (SweSpine).Methods
Pre- and postoperative data were available for 301 non-elective and 2364 elective cases. Patient reported outcome measures (PROMs) were; Visual Analogue Scale (VAS) leg and back pain, Oswestry Disability Index (ODI), EuroQol five-Dimensions (EQ-5D) and patient satisfaction. Postoperative p values were adjusted for baseline differences.Results
Preoperative mean (SD) in the non-elective and elective groups were for VAS leg pain 81 (22) and 65 (24), for VAS back pain 51 (33) and 45 (28), for ODI 66 (20) and 45 (17) and for EQ-5D 0.024 (0.35) and 0.31 (0.33), respectively, (p for all <0.001). Postoperative VAS leg pain was 23 (28) in the non-elective group and 20 (26) in the elective group (p = 0.19). Corresponding figures were for VAS back pain 25 (27) and 24 (27) (p = 0.69), ODI 19 (17) and 17 (17) (p = 0.052) and for EQ-5D 0.70 (0.28) and 0.73 (0.29) (p = 0.73). Patient satisfaction did not differ between the groups (p = 0.78).Conclusions
Even if non-elective patients preoperatively had substantially more pain, higher disability and poorer quality of life than elective patients, postoperative differences were clinically small. Patient satisfaction did not differ.11.
Purpose
Sagittal imbalance of severe adult degenerative deformities requires surgical correction to improve pain, mobility and quality of life. Our aim was a harmonic and balanced spine, treating a series of adult degenerative thoracolumbar and lumbar kyphoscoliosis by a non posterior subtraction osteotomy technique.Methods
We operated 22 painful thoracolumbar and lumbar compensated degenerative deformities by anterior (ALIF), extreme lateral (XLIF) and transforaminal (TLIF) interbody fusion and grade 2 osteotomy (SPO) to restore lumbar lordosis and mobilize the coronal curve. Two-stage surgery, first anterior and after 2 or 3 weeks posterior, was proposed when the Oswestry Disability Index (ODI) was equal to or greater than 50% and VAS more than 5. All patients were submitted to X-ray and clinical screening during pre, post-operative and follow-up periods.Results
We performed 5 ALIFs, 39 XLIFs, 8 TLIFs, 32 SPOs. No major complications were recorded and complication rate was 18% after lateral fusion and 22.7% after posterior approach. Pelvic tilt, lumbar lordosis, sagittal vertical axis and thoracic kyphosis improved (p < 0.05). Clinical follow-up (mean 20.5; range 18–24) was satisfactory in all cases, except for two due to sacroiliac pain. Mean preoperative VAS was 7.7 (range 6–10), while ODI was 67% on average (range 50–78). After two-stage surgery, VAS and ODI decreased, respectively, to 2.4 (range 2–4) and 31% (range 25–45), while their values were 4 (range 2-6) and 35% (range 20–55) at the final follow-up.Conclusion
Current follow-up does not allow definitive conclusions. However, the surgical approach adopted in this study seems promising, improving balance and clinical condition of adult patients with a compensated sagittal degenerative imbalance of the thoracolumbar spine.12.
Yifeng Cai Jiaquan Luo Junjun Huang Chengjie Lian Hang Zhou Hao Yao Peiqiang Su 《International orthopaedics》2016,40(6):1135-1142
Purpose
Our aim is to evaluate the safety and effectiveness of interspinous spacers versus posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal diseases.Methods
A comprehensive literature search was performed using PubMed, Web of Science and Cochrane Library through September 2015. Included studies were performed according to eligibility criteria. Data of complication rate, post-operative back visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, estimated blood loss (EBL), operative time, length of hospital stay (LOS), range of motion (ROM) at the surgical, proximal and distal segments were extracted and analyzed.Results
Ten studies were selected from 177 citations. The pooled data demonstrated the interspinous spacers group had a lower estimated blood loss (weighted mean difference [WMD]: ?175.66 ml; 95 % confidence interval [CI], ?241.03 to ?110.30; p?<?0.00001), shorter operative time (WMD: ?55.47 min; 95%CI, ?74.29 to ?36.65; p?<?0.00001), larger range of motion (ROM) at the surgical segment (WMD: 3.97 degree; 95%CI, ?3.24 to ?1.91; p?<?0.00001) and more limited ROM at the proximal segment (WMD: ?2.58 degree; 95%CI, 2.48 to 5.47; p?<?0.00001) after operation. Post-operative back VAS score, ODI score, length of hospital stay, complication rate and ROM at the distal segment showed no difference between the two groups.Conclusions
Our meta-analysis suggested that interspinous spacers appear to be a safe and effective alternative to PLIF for selective patients with degenerative lumbar spinal diseases. However, more randomized controlled trials (RCT) are still needed to further confirm our results.13.
Zagra Antonino Scaramuzzo Laura Galbusera Fabio Minoia Leone Archetti Marino Giudici Fabrizio 《European spine journal》2015,24(7):924-930
Introduction
Aim of the study was to evaluate the biomechanical stability and the clinical efficacy of a lumbar interbody fusion obtained by single oblique cage implanted by a posterior approach.Method
Through the realization of three finite element models (FEMs), the biomechanics of POLIF was compared to PLIF and TLIF. Ninety-four patients underwent interbody fusion by POLIF with instrumented posterolateral fusion. Clinical and radiographic outcomes were evaluated at regular intervals for at least 6 months.Results
The FEMs showed no statistically significant differences in stability in compression and flexion–extension. Mean preoperative VAS score was 7.1, decreased to 2.1 at follow-up. Mean preoperative SF-12 value was 34.5 %, increased to 75.4 % at follow-up. All patients showed a good fusion rate and no hardware failure.Discussion
POLIF associated to instrumented posterolateral fusion is a viable and safe surgical technique, which ensures a biomechanical stability similar to other surgical techniques.14.
Purpose
The aim of the present study was to examine the natural history in patients with lumbar spinal stenosis. The incidence of surgery for this condition has increased considerably during the past decades in spite of a fairly favorable natural history in previous studies.Methods
146 consecutive patients with clinical signs and image findings of lumbar spinal stenosis, who were not recommended surgical treatment, were followed; the reason as to why surgery was not recommended was a moderate symptom level. The follow-up rate was 89% after 3.3 years. Group values for comorbidities and diagnostic imaging were comparable to patients selected for surgery, with the exception of a lower frequency of degenerative spondylolisthesis among the non-operative patients. The mean age of those observed was 68 (21–91), and 58% were females.Results
During the observation period spontaneous improvements were found for pain and health-related quality of life, but not for walking. Using the minimum clinically important difference for VAS, leg and back pain improved in 32 and 36% of patients, respectively, were unchanged in 55 and 54%, and worsened in 13 and 10%. Findings on diagnostic imaging did not influence patient outcome, except for stenoses with cross-sectional area <0.5 cm2 where spontaneous improvement was not seen. Revision of the decision not to operate occurred in 10 cases (7%).Conclusions
The natural history of LSS with moderate symptom levels rarely shows symptom deterioration over a median of 3.3 years; in fact, a slight improvement of symptoms was seen at group levels. The treatment decision was revised for 7%, and for the rest an increase in pain was seen in 10–13%. The results support reluctance towards surgery, if the symptom levels are tolerable for the patients.15.
Gregory D. Schroeder Cynthia R. LaBella Marco Mendoza Erika L. Daley Jason W. Savage Alpesh A. Patel Wellington K. Hsu 《European spine journal》2016,25(9):2842-2848
Purpose
To determine if adolescent athletics increases the risk of structural abnormalities in the lumbar spine.Methods
A retrospective review of patients (ages 10–18) between 2004 and 2012 was performed. Pediatric patients with symptomatic low back pain, a lumbar spine MRI, and reported weekly athletic activity were included. Patients were stratified to an “athlete” and “non-athlete” group. Lumbar magnetic resonance and plain radiographic imaging was randomized, blinded, and evaluated by two authors for a Pfirrmann grade, herniated disc, and/or pars fracture.Results
A total of 114 patients met the inclusion criteria and were stratified into 66 athletes and 48 non-athletes. Athletes were more likely to have abnormal findings compared to non-athletes (67 vs. 40 %, respectively, p = 0.01). Specifically, the prevalence of a spondylolysis with or without a slip was higher in athletes vs. non-athletes (32 vs. 2 %, respectively, p = 0.0003); however, there was no difference in the average Pfirrmann grade (1.19 vs. 1.14, p = 0.41), percentage of patients with at least one degenerative disc (39 vs. 31 %, p = 0.41), or disc herniation (27 vs. 33 %, p = 0.43). Body mass index, smoking history, and pelvic incidence (51.5° vs. 48.7°, respectively, p = 0.41) were similar between the groups.Conclusion
Adolescents with low back pain have a higher-than-expected prevalence of structural pathology regardless of athletic activity. Independent of pelvic incidence, adolescent athletes with low back pain had a higher prevalence of spondylolysis compared to adolescent non-athletes with back pain, but there was no difference in associated disc degenerative changes or herniation.16.
Purpose
Lumbar epidural injection is a popular treatment for degenerative lumbar disease. Although post-procedural epidural infection is rare, meningitis and epidural abscess are life-threatening conditions, and need additional medical and surgical intervention. The purpose of this article is to report a patient with fatal whole cerebrospinal axis infection after lumbar epidural injections.Methods
A 64-year-old female patient presented with septic shock and quadriparesis. In the past, this patient had received lumbar epidural injections several times for degenerative spondylolisthesis at L4-5 in another hospital. The magnetic resonance imaging showed epidural abscess, a compressed dura and spinal cord from C1 to S2, and cerebral meningitis. We performed laminectomies and removal of the abscesses. Her mental status was diminished to a deep, drowsy state after three postoperative weeks. Brain computed tomography scans revealed hydrocephalus. Therefore, ventriculoperitoneal shunting was performed.Results
Methicillin resistant Staphylococcus epidermidis was cultured from blood samples. The patient’s infection was completely controlled and her mental status improved to alert; however, her quadriparesis remained.Conclusions
Although lumbar epidural injection is an effective procedure to treat lumbar radicular pain, this procedure can induce fatal complications such as sepsis and epidural abscess.Level of evidence
5.17.
Zuo Zhenbo Li Huanting Wang Jin Gong Haifeng Fang Yuan Li Ming 《European spine journal》2016,25(11):3393-3402
Purpose
The present report intended to introduce the hemilaminoplasty technique and evaluate the efficacy of our surgical procedure for LISCs.Methods
This retrospective study was conducted to analyze the results in 24 LISCs who had undergone our hemilaminoplasty between 2000 and 2012 in two hospitals. All were confirmed by pathological histology and mid- to long-term follow-up had been performed in all cases with a mean of 4.9 years. Using the Japanese Orthopedic Association scoring system (JOA score) and visual analog scale (VAS), symptoms resulting from cyst compression were quantified at various stage for statistical analysis.Results
The JOA score and VAS of back/leg pain following surgery were improved significantly (P < 0.01). At final follow-up, with normal aging there was a little decrease in JOA score and VAS of back/leg pain, but still significantly improved (P < 0.01). Similarly, mean improvement rate of JOA was 83.5 % at 1 year after surgery while 75.6 % at final visit. Successful bone healing was obtained at a mean of 3.8 months after surgery. No cyst reformation and recurrent back/leg pain were observed around the surgical sites.Conclusions
These lesions could be regarded as a result of facet arthrosis/instability and repetitive facet minor trauma with herniation of synovium through the defective joint capsule. Improvement in lumbago and leg pain may be a consequence of complete cyst resection via hemilaminoplasty plus partial facetectomy with anatomical reconstruction of the posterior spinal elements.18.
Background
Surgical site infection is a catastrophic complication after spinal surgery, which seriously affects the progress of rehabilitation and clinical outcome. Currently the clinical reports on spinal surgical site infections are mostly confined to the surgical segment itself and there are few reports on adjacent segment infections after spinal surgery.Study design
Case report.Objective
To report a clinical case with adjacent level infection after spinal fusion.Methods
We report the case of a 68-year-old woman who underwent posterior lumbar 4?5 laminectomy, posterolateral fusion and internal fixation. The patient showed signs of surgical site infection, such as surgical site pain, high fever and increase of the inflammatory index 1 week after the operation. Magnetic resonance imaging (MRI) confirmed the diagnosis of adjacent intervertebral disc infection. The patient received early combined, high-dose anti-infection treatment instead of debridement.Results
After the conservative treatment, the infection was controlled and the patient subsequently enjoyed a normal daily life.Conclusion
Adjacent level infections can occur after spinal surgery. Early diagnosis and anti-infection treatment played an important role in the treatment of this kind of complication.19.