Objectives To verify the hypothesis that nerve compression by postoperative spinal epidural hematoma (POSEH) can be reduced by instillation of heparin through suction drains.
Materials and Methods The patients who underwent posterior decompression and instrumentation between Jan. 2016 and Jun 2016 were allocated to study (using heparin) group and control group according to the operation date alternately. There were 61 cases in study group and 60 cases in control group. Two lines of suction drain were used in all cases. Thousand unit of heparin and 5ml of normal saline were instilled through the drain lines into the epidural space just before the wound closure. To prove the homogeneity between the two groups, demographic, patient related, operation related and clotting related data were compared. At day 7 after the operation, their MRIs were examined. The area of thecal sac was measured at the T2 weighted axial image that showed the maximal compression of the thecal sac by epidural hematoma. Two orthopedic doctors who were blinded to this study measured independently and the average values of the two were counted as final measured values.
Results The two groups were homogenous in age, sex, number of fusion segments, whether virgin or revision operation, total blood loss, operation time, blood loss/10 min, whether taking anti-platelet drugs or not, platelet count, PT, aPTT and platelet function analysis. The smallest area of thecal sac in axial MRI was 124.4±49.9 mm2 in study group and 121.7±47.4 mm2 in control group. There was no significant difference (p=0.761)
Conclusions In a posterior spine surgery, thecal sac compression by POSEH was not reduced by instillation of heparin into the epidural space.
Background Lumbar Arthroscopic Spinal Surgery (LASS) has several advantages compared to conventional procedures in terms of improved visual field, versatility with instrumentation, and ease of handling.
Purpose: To report the learning curve of LASS for more than 10 years by an experienced spine surgeon.
Materials and Methods We retrospectively reviewed medical records of the patients who underwent LASS from Dec. 29th, 2017 to April 31st, 2018. Lumbar Arthroscopic Discectomy (LADi), Lumbar Arthroscopic Decompression (LAD), Lumbar Arthroscopic Foraminoplasty (LAF) were performed. Operation time, the amount of bleeding, the length of hospital stay and the degree of postoperative pain were analyzed to evaluate the learning curve.
Results 28 cases (90.3%) showed satisfactory postoperative results. The operation time per segment was 124.2±58.5 minutes (range 45~247). The mean operation time for LADi was 91.4±62.7 minutes (45~247), for LAD was 136.1±53.8 minutes (68~222 minutes) and for LAF was 135.3±50.6 minutes (72~245), and was indicating a declining trend. In the LAF, the slope of the decline of the learning curve was gentle compared to other operations.
Conclusion The results of short-term follow-up of LASS are excellent, and it is easy to acquire skills in experienced spine surgeon.
Objectives We report the new minimally invasive technique and its clinical results of oblique lumbar interbody fusion (OLIF) combined with central decompression using biportal endoscopic spinal surgery (BESS).
Summary of Literature Review: The OLIF procedure is one of the minimally invasive spine surgeries and is being frequently attempted recently to treat lumbar degenerative disease. It has been reported that it effectively decompresses foraminal stenotic lesions indirectly by inserting a large cage anteriorly, which reduces spondylolisthesis and widens the disc space. However, OLIF has limited effect for severe central canal stenosis, since it cannot achieve direct decompression. Therefore, authors report a new minimally invasive technique of OLIF combined with direct central decompression using BESS for severe central stenosis along with its clinical results as a pilot study.
Materials and Methods For patients who were candidate for fusion surgery due to spondylolisthesis (more than one segment) or foraminal stenosis, authors performed OLIF and central decompression using BESS simultaneously, when the patients had concomitant severe central canal stenosis. From June to December, 2017, 8 patients (16 levels) were enrolled, the operative time, blood loss, complications and clinical results have been evaluated. The clinical results were analyzed by Visual analog scale (VAS) scores, Oswestry disability index (ODI) and Roland Morris Disability Questionnaire (RMDQ) of preoperative, 1month, 3month postoperative and final follow-up.
Results Mean operative time and blood loss were 238.4 minutes and 173.3ml, respectively. In all cases, there were no operative complications, and mean follow-up period was 7.1 months. The mean back VAS, lower extremity VAS, ODI, and RMDQ at the final follow-up were improved from 5.4±2.4 to 2.0±0.9, 7.0±1.1 to 1.6±1.7, 64.2±11.8 to 44.2±10.6, and from 17.5±4.2 to 12.9±4.0.
Conclusion A new combination technique of OLIF and BESS for direct decompression can be regarded as effective alternative procedure to treat the foraminal and central stenotic lesions of lumbar degenerative disease.
Purpose There were few available data regarding the prognosis after the surgical treatment for spinal metastases from non-small cell lung cancer (NSCLC) despite its great frequency. The aim of this study was to investigate the prognostic factors for patients who underwent the surgical treatment for spinal metastases from NSCLC.
Materials and Methods Eighty-seven patients who underwent surgical treatment for spinal metastases from NSCLC were followed up semi-prospectively. There were 43 patients with metastatic spinal cord compression (MSCC) and 44 patients without MSCC. The prognosis analysis was performed according to 3-categorical variables: patients’ , oncologic, and treatments’ factors. Major complications and mortality rate were recorded. The impact of postoperative chemotherapy was evaluated separately.
Results The overall survival time was median 6.8 months. Postoperative ECOG-PS (0-2 vs. 3, 4) was shown as a significant prognostic factors in both MSCC and non-MSCC groups with HR (hazards ratio) of 2.46 and 2.54, respectively. Major complications developed in 26 patients and 30-day mortality rate was 8.0%. The presence of major complications was also prognostic factor in both groups with HR of 2.55 and 4.47. Earlier surgery within 72 hours showed better prognosis in MSCC group with HR of 2.46. Patients who underwent postoperative chemotherapy survived longer significantly than those who couldn’t with median survival time of 12.0 vs 2.8 months.
Conclusions Postoperative ECOG-PS and complications were significant prognostic factors in both groups and earlier surgery in MSCC group. The postoperative chemotherapy was another independent prognostic factor affecting the survival time
Seventy-four-year female patient presented back pain, radiating pain from both posterior thigh and intermittent claudication for two years. Preoperative radiography and MRI demonstrated L2~S1 spinal stenosis. She underwent OLIF and posterior instrumentation L2-S1. At 3 days postoperatively, she presented nausea, abdominal discomfort and showed low SpO2 and drowsy mental state with abrupt vomiting. Abdomen X-ray and CT demonstrated severe paralytic ileus and Chest CT and bronchoscopy demonstrated aspiration pneumonia and ARDS. She transferred to respiratory internal medicine in intensive care unit. She recovered for one month of ICU care and was possible to wheelchair ambulation. Approximately 3.5% of patients undergoing elective spine surgery develop paralytic ileus.
Especially, anterior or lateral access spine surgery, gastroesophageal reflux disease and posterior instrumentation have a high risk of ileus. If patients present nausea, vomiting, abdominal discomfort, constipation, doctor must be evaluated paralytic ileus and treat it by NPO, early ambulation, nasogastric tube and possible pharmacological agents.
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