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Sylvain Palmer

Object

Application of minimally invasive techniques to lumbar disc surgery has led to the development of the Microscopic Endoscopic Tubular Retractor System (METRx-MD). A prospective evaluation of results and complications was undertaken.

Methods

One hundred thirty-five patients underwent surgery in which the METRx-MD system was used; most procedures were performed on an outpatient basis, and general anesthesia was induced in all cases. All patients were followed prospectively. Outcomes were measured using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short Form–36 (SF-36) questionnaires. Follow-up data were collected by an outside company, which also tabulated the data.

Data were collected in 129 of 135 patients. Improvement was seen on the VAS (Scores 7–2), ODI (Scores 57–16), and SF-36 scales (bodily pain Scores 20–60). Patient satisfaction with results was 94% and with office services 88%. Thirty-six percent of patients returned to work at 0 to 2 weeks, 38% at 3 to 5 weeks, and 25% at 5 to 26 weeks. Hospital charges decreased by $2395 (18%).

The mean operative time was 66 minutes, and the mean blood loss was 22 ml. Complications included one superficial wound infection, one discitis, three durotomies, and three cases of excessive bleeding (> 100 ml). There were five reoperations: four for recurrent disc herniations, (two ipsilateral and two contralateral to the index site) and one for spinal stenosis contralateral to the index site.

Conclusions

Minimally invasive surgery in which the METRx-MD system is used is clinically effective and cost effective. Patient satisfaction was high. A mean per case cost savings of $2395 was realized. Complications rates were comparable with those associated with traditional microdiscectomy procedures.

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Preneshlin V. Govender, Yoga R. Rampersaud, Lynda Rickards and Michael G. Fehlings

Object

The safety and effectiveness of osteogenic protein (OP)–1 putty (recombinant human bone morphogenetic protein–7) in promoting fusion in complex spinal cases was studied in nine cases.

Methods

The authors prospectively evaluated nine patients requiring spinal fusion in whom there were medical risk factors that would inhibit osseous fusion. Intraoperatively the OP-1 putty mixed with autologous bone was placed at the fusion site. Outcome measurement instruments were used to provide information on patient demographics, comorbidities, and pain. The Short Form (SF)–36 questionnaire and Oswestry Disability Index (ODI) were administered pre- and postoperatively. All patients underwent routine radiography of the surgery site during follow-up examination.

The age of the five women and four men ranged from 21 to 74 years (mean height 1.6 m, mean weight 76.7 kg). Risk factors included mucopolysaccharide syndrome, adrenal insufficiency, rheumatoid arthritis with chronic corticosteroid use, morbid obesity, and heavy smoking. Surgery, which consisted of five cervical and four lumbar procedures, including intradural surgery in three patients, was uneventful in all cases without perioperative complication. The follow-up period ranged from 1 to 15 months (mean 5.22 months). The ODI score changed from severe disability (mean 46.89) pre-operatively to minimal and moderate disability (mean 34.56) postoperatively. The SF-36 survey showed overall improved mental and physical health scores. Fusion was present in all patients with greater than 3 months follow up.

Conclusions

The OP-1 putty appears to be safe and effective in promoting spinal arthrodesis in patients in whom adverse medical risk factors exist.

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Jean-Valéry C. E. Coumans, Mary-Kay Reinhardt and Isador H. Lieberman

postoperative SF-36 questionnaires, VAS, and ODI scale were scored and compared using a two-tailed paired t-test. The two-tailed t-test was used to avoid making assumption as to the direction of change of the scores, given the absence of long-term data. A probability value of less than 0.05 was considered significant. The outcome variables included the SF-36, VAS, and ODI scores, the occurrence of extravasation, and postoperative 30-day morbidity and mortality. Results Fractures were treated between T-5 and L-5, but most were located at the thoracolumbar junction

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Peter C. Gerszten, John J. Moossy, John C. Flickinger and William C. Welch

of subluxation); and 11) inability to undergo MR imaging. Data Analysis The outcome instrument used was the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire that included the SF-36 Health Status Questionnaire 52 as well as the ODI for low-back pain. 13 Quality of life and disability data were obtained at baseline, 6 weeks, 3 months, and 1 year after treatment. An online data collection system (Outcomes Sciences, Boston, MA) was used throughout this study for data

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Selection of instrumentation and fusion levels for scoliosis: where to start and where to stop

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Keith H. Bridwell

showing the improvement in the axial plane due to the thoracoplasty. E: Graph demonstrating postoperative SRS scores converted to 100-point scale. A selective thoracic fusion was performed to the stable vertebra, that is, L-1. Fusion, placement of instrumentation, and thoracoplasty were performed. The translational deformity improved by instrumentation-assisted fusion, and the axial deformity was corrected by the thoracoplasty. The patient's postoperative SRS score was extremely high. A high SRS score and a low ODI score are both good and comparable. A high SRS

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Fred H. Geisler, Scott L. Blumenthal, Richard D. Guyer, Paul C. McAfee, John J. Regan, J. Patrick Johnson and Bradford Mullin

L4–5 or L5—S1 confirmed by MR imaging and provocative discography, age 18 to 60 years, ODI score greater than or equal to 30, back pain VAS-rated score greater than or equal to 40 with no radicular component (referred leg pain was permitted), and failed nonoperative treatment of at least 6 months' duration. The primary exclusion criteria included previous thoracic or lumbar fusion, multilevel DDD, facet joint arthrosis, noncontained herniated nucleus pulposus, osteoporosis, spondylolisthesis slip greater than 3 mm, scoliosis greater than 11°, and midsagittal

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Bone morphogenetic proteins in anterior lumbar interbody fusion: old techniques and new technologies

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

J. Kenneth Burkus

water and a single dose at a concentration of 1.5 mg/ml. 17 The concentration was the same in all cases and in all studies. 2, 21 The solution was applied to an absorbable collagen sponge, which was then placed into the central portion of the threaded cages. The total dose of rhBMP-2 that each patient received ranged from 8 to 12 ml and depended on the size of the implanted cage (16, 18, or 20 mm). No autologous graft or local bone reaming was used in the investigational groups. Clinical Outcome Measurements The ODI, the PCS of the SF-36, and questions

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Zoher Ghogawala, Edward C. Benzel, Sepideh Amin-Hanjani, Fred G. Barker II, J. Fred Harrington, Subu N. Magge, John Strugar, Jean-Valéry C.E. Coumans and Lawrence F. Borges

stenosis. Patients with a history of laminectomy at the level of the spondylolisthesis were excluded. Cases involving gross instability (> 3 mm on flexion—extension radiographs of the lumbar spine) were also excluded. Data were collected by nurse coordinators who reviewed the operative notes from both surgeons performing the procedures between 2000 and 2002. Both surgeons routinely collected ODI and SF-36 data before and after spinal stenosis surgery during this period. Institutional review board approval was obtained from both institutions. The surgical strategy was

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Aaron G. Filler, Jodean Haynes, Sheldon E. Jordan, Joshua Prager, J. Pablo Villablanca, Keyvan Farahani, Duncan Q. Mcbride, Jay S. Tsuruda, Brannon Morisoli, Ulrich Batzdorf and J. Patrick Johnson

overnight. Outcome Measures Outcomes were assessed using a modified ODI questionnaire in parallel with routine clinical follow-up examination and supplementary questionnaires. No outcome measure has been validated for piriformis syndrome because this study was intended to help establish the validity of that diagnosis. The ODI functional outcome scale was selected in place of a visual analog pain scale by analogy with the use of ODI for lumbar spine surgery outcomes. 10, 16 A six-point difference was considered clinically relevant for the fundamentally

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that invalidate some of the important conclusions of the article and mislead readers in clinical implications of specific and general statistical methodology. 3 The authors presented clinical outcomes from the Investigational Device Exemptions (IDE) study with the Charité artificial disc. In their report, the mean improvement and standard deviations (SDs) of Oswestry Disability Index (ODI) scores of the patients in the Charité disc study were compared with those who underwent state-of-the-art fusion techniques of stand-alone anterior lumbar interbody fusion (ALIF