Here are eight recent studies impacting spine surgeons.
1. Combined Posterior-Anterior Approach Effective for Treating Spinal Tumors. Researchers studied six aggressive benign tumors and four solitary spinal metastases treated with the posterior-anterior approach and published the study in Spine.
For the posterior approach, dissection of the lumbar nerve roots to the conjunction of the adjacent nerves after en bloc laminectomy by T-saw pediculotomy. The psoas muscle is dissected away from the vertebral body, and the posterior halves of the anterior column at the craniocaudal adjacent levels of the lumbar tumor are cut. For the anterior approach, major vessels are dissected from the vertebral body, and the anterior halves of the anterior column are cut at the corresponding levels. The tumor vertebral body is removed en bloc and then an anterior spinal reconstruction is performed.
Seven of the 10 cases had no disease evidence at 57 months after the surgery. One case was alive with disease at 66 months, and two cases had a death from the disease.
2. 2D Virtual Fluoroscopy Acceptable for Pedicle Screw Placement. The MIS-2D-CAS technique was used to place pedicle screws in 41 patients undergoing minimally invasive interbody instrumented fusion. The patients were examined postoperatively using CT scans.
There were no neurologic, vascular or visceral injuries in the patients. Screws breached the pedicle 23 percent of the time, and 83.8 percent of the breaches were graded II. There were five Grade III and Grade IV breaches. Twelve percent of the pedicle screws had trajectories that deviated from "acceptable." Fluoroscopy time for screw placement was typically less than 20 seconds per case, and there was one clinically significant breach in the L5 which resulted in radiculopathy. The study was published in Spine.
3. Minimally Invasive XLIF and Effective for Elderly Patients. In a single-site prospective examination, 40 Extreme Lateral Interbody Fusion patients aged 80 or older were identified. Their outcomes were compared with those of 20 patients in the same age group who underwent the traditional open posterior lumbar interbody fusion.
Researchers found no statistically significant differences in demographics, diagnoses or comorbidities between the groups. Complications, blood loss/transfusion rate and hospital stay were in the group receiving minimally invasive surgery. The patients undergoing minimally invasive surgery left the hospital an average of four days earlier than those who underwent the open PLIF procedure. Six deaths occurred among the open surgery patients, while one death occurred among the patients treated with the minimally invasive procedure six months after the surgery. The study was published in Spine.
4. Nucleoplasty May Not Be An Effective Procedure. Researchers examined 28 consecutive patients with persistent symptoms after nucleoplasty within one year of treatment using prenucleoplasty and postnucleoplasty MRIs and published the findings in the Journal of Spinal Disorders & Techniques. The comparison between the two MRIs failed to show an increase in signal hydration, disc space height or shrinkage of the preoperative disc bulge.
Of the 17 cervical levels treated in the 12 patients, five seemed to show progressive degeneration at treated levels. Of the 17 lumbar procedures done in 16 patients, four seemed to show progressive degeneration and one developed spondylolisthesis.
5. Surgical Intervention is Better for Appropriately Indicated Patients. According to the outcome of The Spine Patient Outcomes Research Trial comparing surgical and nonsurgical outcomes for three common lumbar spine diagnoses, surgery provides a better treatment option for patients who are appropriately indicated.
SPORT’s findings were presented at the 2010 North American Spine Society annual meeting and included patients who had intervertebral disc herniation, spinal stenosis and degenerative spondylolisthesis. The researchers followed 1,192 patients, 788 of which underwent discectomy for disc herniation. The rest received nonsurgical treatment. The treatment effect was substantially different between subgroups. It was found that patients who didn't have joint problems and those who were married improved more than others.
6. Mini-Open Lateral Approach Effective for Thoracic Spine Tumor Removal. An examination of 21 patients treated between 2007 and 2009 with the mini-open lateral approach to minimally invasive thoracic spine surgery to remove tumors was conducted for the study. The average operating time was 117 minutes, average blood loss was 291 mL and average length of stay in the hospital was 2.9 days.
Of the 21 patients, one experienced perioperative complications while two patients were found to have residual tumors at the follow-up visit. Two patients died during the study as a result of other metastases. Among the other patients, the visual analog scale improved from 7.7 to 2.9 on average, and the Oswestry disability index improved from 52.7 percent to 24.9 percent. The results of the study were published in Spine.
7. Asking Radiologists to Report on Vertebral Arteries Increases Identification. Six neuroradiologists were asked to interpret 79 cervical spine MRIs, 39 of which had aberrant vertebral arteries. The initial indications for the study only included a description of the patient's symptoms. The radiologists were then given the same MRIs with different indications, including the patient's symptoms, a request for annotations on the vertebral artery and a definition of the vertebral artery anomaly.
When the indications of the study only included a description of the patient's symptoms, the vertebral artery was never described by the radiologists. When the indications included the specific request and definition, all radiologists commented on them. Three of the radiologists were 100 percent accurate in identifying the aberrant vertebral arteries. The study was published in Spine.
8. Complication Rates Greater for Open TLIF Than Minimally Invasive TLIF. From the 23 identified articles, the TLIF was performed with pedicle fixation and the fusion was evaluated using radiograph or CT scan. The studies included 1,028 patients and showed the usage of recombinant bone morphologic protein was higher among the mTLIF group.
Mean fusion rates for open TLIF was 90 percent, whereas the mean fusion rate from the mTLIF was 94.8 percent. Complication rate was 12.6 percent for open TLIF and 7.5 percent for mTLIF. The review was published in Spine.
1. Combined Posterior-Anterior Approach Effective for Treating Spinal Tumors. Researchers studied six aggressive benign tumors and four solitary spinal metastases treated with the posterior-anterior approach and published the study in Spine.
For the posterior approach, dissection of the lumbar nerve roots to the conjunction of the adjacent nerves after en bloc laminectomy by T-saw pediculotomy. The psoas muscle is dissected away from the vertebral body, and the posterior halves of the anterior column at the craniocaudal adjacent levels of the lumbar tumor are cut. For the anterior approach, major vessels are dissected from the vertebral body, and the anterior halves of the anterior column are cut at the corresponding levels. The tumor vertebral body is removed en bloc and then an anterior spinal reconstruction is performed.
Seven of the 10 cases had no disease evidence at 57 months after the surgery. One case was alive with disease at 66 months, and two cases had a death from the disease.
2. 2D Virtual Fluoroscopy Acceptable for Pedicle Screw Placement. The MIS-2D-CAS technique was used to place pedicle screws in 41 patients undergoing minimally invasive interbody instrumented fusion. The patients were examined postoperatively using CT scans.
There were no neurologic, vascular or visceral injuries in the patients. Screws breached the pedicle 23 percent of the time, and 83.8 percent of the breaches were graded II. There were five Grade III and Grade IV breaches. Twelve percent of the pedicle screws had trajectories that deviated from "acceptable." Fluoroscopy time for screw placement was typically less than 20 seconds per case, and there was one clinically significant breach in the L5 which resulted in radiculopathy. The study was published in Spine.
3. Minimally Invasive XLIF and Effective for Elderly Patients. In a single-site prospective examination, 40 Extreme Lateral Interbody Fusion patients aged 80 or older were identified. Their outcomes were compared with those of 20 patients in the same age group who underwent the traditional open posterior lumbar interbody fusion.
Researchers found no statistically significant differences in demographics, diagnoses or comorbidities between the groups. Complications, blood loss/transfusion rate and hospital stay were in the group receiving minimally invasive surgery. The patients undergoing minimally invasive surgery left the hospital an average of four days earlier than those who underwent the open PLIF procedure. Six deaths occurred among the open surgery patients, while one death occurred among the patients treated with the minimally invasive procedure six months after the surgery. The study was published in Spine.
4. Nucleoplasty May Not Be An Effective Procedure. Researchers examined 28 consecutive patients with persistent symptoms after nucleoplasty within one year of treatment using prenucleoplasty and postnucleoplasty MRIs and published the findings in the Journal of Spinal Disorders & Techniques. The comparison between the two MRIs failed to show an increase in signal hydration, disc space height or shrinkage of the preoperative disc bulge.
Of the 17 cervical levels treated in the 12 patients, five seemed to show progressive degeneration at treated levels. Of the 17 lumbar procedures done in 16 patients, four seemed to show progressive degeneration and one developed spondylolisthesis.
5. Surgical Intervention is Better for Appropriately Indicated Patients. According to the outcome of The Spine Patient Outcomes Research Trial comparing surgical and nonsurgical outcomes for three common lumbar spine diagnoses, surgery provides a better treatment option for patients who are appropriately indicated.
SPORT’s findings were presented at the 2010 North American Spine Society annual meeting and included patients who had intervertebral disc herniation, spinal stenosis and degenerative spondylolisthesis. The researchers followed 1,192 patients, 788 of which underwent discectomy for disc herniation. The rest received nonsurgical treatment. The treatment effect was substantially different between subgroups. It was found that patients who didn't have joint problems and those who were married improved more than others.
6. Mini-Open Lateral Approach Effective for Thoracic Spine Tumor Removal. An examination of 21 patients treated between 2007 and 2009 with the mini-open lateral approach to minimally invasive thoracic spine surgery to remove tumors was conducted for the study. The average operating time was 117 minutes, average blood loss was 291 mL and average length of stay in the hospital was 2.9 days.
Of the 21 patients, one experienced perioperative complications while two patients were found to have residual tumors at the follow-up visit. Two patients died during the study as a result of other metastases. Among the other patients, the visual analog scale improved from 7.7 to 2.9 on average, and the Oswestry disability index improved from 52.7 percent to 24.9 percent. The results of the study were published in Spine.
7. Asking Radiologists to Report on Vertebral Arteries Increases Identification. Six neuroradiologists were asked to interpret 79 cervical spine MRIs, 39 of which had aberrant vertebral arteries. The initial indications for the study only included a description of the patient's symptoms. The radiologists were then given the same MRIs with different indications, including the patient's symptoms, a request for annotations on the vertebral artery and a definition of the vertebral artery anomaly.
When the indications of the study only included a description of the patient's symptoms, the vertebral artery was never described by the radiologists. When the indications included the specific request and definition, all radiologists commented on them. Three of the radiologists were 100 percent accurate in identifying the aberrant vertebral arteries. The study was published in Spine.
8. Complication Rates Greater for Open TLIF Than Minimally Invasive TLIF. From the 23 identified articles, the TLIF was performed with pedicle fixation and the fusion was evaluated using radiograph or CT scan. The studies included 1,028 patients and showed the usage of recombinant bone morphologic protein was higher among the mTLIF group.
Mean fusion rates for open TLIF was 90 percent, whereas the mean fusion rate from the mTLIF was 94.8 percent. Complication rate was 12.6 percent for open TLIF and 7.5 percent for mTLIF. The review was published in Spine.