Background: Unsuccessful medical treatment of pyogenic multifocal spondylodiscitis including signs of sepsis and unremitting pain is challenging. The aim of our report was to present a case of ...multilevel spondylodiscitis successfully treated by posterior lumbar interbody fusion using porous tantalum cages.Case presentation: A 59-year-old male was diagnosed with spondylodiscitis at T8-T9 level. Although treated with antibiotics, the patient again presented with worsening of systemic signs of infection and back pain. Contrast-enhanced magnetic resonance imaging studies revealed spondylodiscitis at L1 to S1 level. Posterior lumbar interbody bone fusion with tantalum cages from L1 to S1 was performed. The inflammation rapidly subsided. Computer tomography studies showed a stable construct at 24 months.Conclusion: Porous tantalum cages used in combination with transpedicular fixation seem to be a sound alternative to interbody devices made from other materials when treating spondylodiscitis cases without definite osseous destruction.
The advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical solution that dwells on the wound have been shown to include removal of fibrinous and ...bacterial exudate and increased granulation tissue formation. The treatment is best suited for chronic, complex wounds with areas of nonviable tissue on the wound surface.
A 73-year-old female with spondylolisthesis and stenosis of the spinal canal experienced dehiscence formation of the postoperative wound with continuous exudate after fusion and decompression surgery (TLIF L4-L5) of the lumbar spine. As a result, she had a complicated clinical course with multiple revision surgeries. Negative pressure wound therapy with continuous negative pressure was utilized for about 6 weeks, and regular dressing changes (saline gauze and honey dressings) were performed every day until NPWTi-d treatment was initiated; this protocol was not successful, so NPWTi-d with saline solution was initiated (average instillation time, 4 hours; dwell time, 15 minutes; continuous negative pressure, -125 mm Hg). During the course of therapy, 10 dressing changes were performed 3 to 5 days apart. After 31 days of therapy, healthy granulation tissue with minimal exudate was noted. Complete wound closure was achieved after 5 months of treatment.
Negative pressure wound therapy with instillation and dwell time can enhance the healing potential of a complex surgical wound after spinal fusion.
The case describes a 59-year-old male patient who suffered from a solitary metastasis of unknown origin in the L1 vertebra. Owing to the instability, a corpectomy and posterior fixation with the ...expandable cage implantation was performed. However, the disease progressed, which required additional nonadjacent corpectomy and cranial elongation of the construct with implantation of the additional expandable cage at the level Th11.
In such complex pathology, two single-level nonadjacent corpectomies and expandable cage implantations present a surgical solution that may provide a satisfactory outcome.
Uvod: Rekonstrukcija sprednje križne vezi kolena spada med uveljavljene metode zdravljenja po pretrganju sprednjega križnega ligamenta. Pomembno je oceniti celoten vpliv posega na zdravje ...posameznika, ki se lahko odraža v kakovosti življenja. Namen raziskave je bil ugotoviti, kakšna je kakovost življenja pacientov po rekonstrukciji sprednje križne vezi.Metode: Uporabljen je bil integrativni pregled literature na podlagi metodologije PRISMA. Vključene so bile raziskave iz obdobja od 2009 do 2019. Iskanje literature je potekalo v podatkovnih bazah PubMed, MEDLINE, CINAHL, ScienceDirect, Web of Science in COBISS. Izvedena je bila vsebinska analiza spoznanj raziskav.Rezultati: Izmed 1.141 identificiranih zadetkov je bilo v končno analizo vključenih 21 raziskav. Ugotovljeno je bilo, da se lahko po rekonstrukciji sprednje križne vezi uporabljajo vprašalniki in lestvice, ki ocenjujejo dva vidika: kakovost življenja, povezano s kolenom, in kakovost življenja, povezano z zdravjem. V večini raziskav so poročali o dobri kakovosti življenja. Boljši rezultati se navajajo pri merjenju kakovosti življenja, povezani z zdravjem. Na rezultate in izide kakovosti življenja po posegu lahko vpliva več različnih dejavnikov.Diskusija in zaključek: Rekonstrukcija sprednje križne vezi lahko vpliva na kakovost življenja pacientov. Ugotovitve raziskav lahko koristijo na področju predoperativne zdravstvene vzgoje pacientov glede kratkoročnih in dolgoročnih izidov po posegu ter pri razvoju strategij izboljšanja pooperativne kakovosti življenja.
Uvod: Rekonstrukcija sprednje križne vezi kolena spada med uveljavljene metode zdravljenja po pretrganju sprednjega križnega ligamenta. Pomembno je oceniti celoten vpliv posega na zdravje ...posameznika, ki se lahko odraža v kakovosti življenja. Namen raziskave je bil ugotoviti, kakšna je kakovost življenja pacientov po rekonstrukciji sprednje križne vezi. Metode: Uporabljen je bil integrativni pregled literature na podlagi metodologije PRISMA. Vključene so bile raziskave iz obdobja od 2009 do 2019. Iskanje literature je potekalo v podatkovnih bazah PubMed, MEDLINE, CINAHL, ScienceDirect, Web of Science in COBISS. Izvedena je bila vsebinska analiza spoznanj raziskav. Rezultati: Izmed 1.141 identificiranih zadetkov je bilo v končno analizo vključenih 21 raziskav. Ugotovljeno je bilo, da se lahko po rekonstrukciji sprednje križne vezi uporabljajo vprašalniki in lestvice, ki ocenjujejo dva vidika: kakovost življenja, povezano s kolenom, in kakovost življenja, povezano z zdravjem. V večini raziskav so poročali o dobri kakovosti življenja. Boljši rezultati se navajajo pri merjenju kakovosti življenja, povezani z zdravjem. Na rezultate in izide kakovosti življenja po posegu lahko vpliva več različnih dejavnikov. Diskusija in zaključek: Rekonstrukcija sprednje križne vezi lahko vpliva na kakovost življenja pacientov. Ugotovitve raziskav lahko koristijo na področju predoperativne zdravstvene vzgoje pacientov glede kratkoročnih in dolgoročnih izidov po posegu ter pri razvoju strategij izboljšanja pooperativne kakovosti življenja.
Uvod: Rekonstrukcija sprednje križne vezi kolena spada med uveljavljene metode zdravljenja po pretrganju sprednjega križnega ligamenta. Pomembno je oceniti celoten vpliv posega na zdravje ...posameznika, ki se lahko odraža v kakovosti življenja. Namen raziskave je bil ugotoviti, kakšna je kakovost življenja pacientov po rekonstrukciji sprednje križne vezi. Metode: Uporabljen je bil integrativni pregled literature na podlagi metodologije PRISMA. Vključene so bile raziskave iz obdobja od 2009 do 2019. Iskanje literature je potekalo v podatkovnih bazah PubMed, MEDLINE, CINAHL, ScienceDirect, Web of Science in COBISS. Izvedena je bila vsebinska analiza spoznanj raziskav. Rezultati: Izmed 1.141 identificiranih zadetkov je bilo v končno analizo vključenih 21 raziskav. Ugotovljeno je bilo, da se lahko po rekonstrukciji sprednje križne vezi uporabljajo vprašalniki in lestvice, ki ocenjujejo dva vidika: kakovost življenja, povezano s kolenom, in kakovost življenja, povezano z zdravjem. V večini raziskav so poročali o dobri kakovosti življenja. Boljši rezultati se navajajo pri merjenju kakovosti življenja, povezani z zdravjem. Na rezultate in izide kakovosti življenja po posegu lahko vpliva več različnih dejavnikov. Diskusija in zaključek: Rekonstrukcija sprednje križne vezi lahko vpliva na kakovost življenja pacientov. Ugotovitve raziskav lahko koristijo na področju predoperativne zdravstvene vzgoje pacientov glede kratkoročnih in dolgoročnih izidov po posegu ter pri razvoju strategij izboljšanja pooperativne kakovosti življenja.
Summary
BACKGROUND: Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and ...hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. PURPOSE: To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. BASIC PROCEDURE: Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. MAIN FINDINGS: Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 ± 1.8 mm in the control group and 3.1 ± 2.5 mm in the platelet gel group (
P
= 0.011). PRINCIPAL CONCLUSION: Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.
Summary
The aim of the study was to evaluate differences in knee injuries and osteoarthritis between the dominant and non-dominant legs of former professional football players. The study cohort ...comprised 40 retired professional players with an average age of 49.2 years. Participants completed a questionnaire about their sports and personal history with special emphasis on knee injuries/operations of the dominant and non-dominant leg. Bilateral standing knee radiographs were taken. Overall, 29 footballers (73%) had experienced at least one moderate or severe knee injury and 18 (40%) had undergone at least one knee operation during their career. Among those injured, 14 (35%) players had suffered a dominant knee injury and 22 (55%) a non-dominant knee injury. Evidence of osteoarthritis (Kellgren–Lawrence scale ≥ 2) was found in 17 (43%) dominant and 23 (58%) non-dominant knees. Professional football players have a significant risk of knee injuries and early osteoarthritis with preponderance in the non-dominant leg.
Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above ...the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique.
Objective：Free-hand pedicle screw placement has a high incidence of pedicle perforation which can be reduced with fluoroscopy,navigation or an alternative rapid prototyping drill guide template.In ...our study the error rate of multi-level templates for pedicle screw placement in lumbar and sacral regions was evaluated.Methods：A case series study was performed on 11 patients.Seventy-two screws were implanted using multilevel drill guide templates manufactured with selective laser sintering.According to the optimal screw direction preoperatively defined,an analysis of screw misplacement was performed.Displacement,deviation and screw length difference were measured.The learning curve was also estimated.Results：Twelve screws （17％） were placed more than 3.125 mm out of its optimal position in the centre of pedicle.The tip of the 16 screws （22％） was misplaced more than 6.25 mm out of the predicted optimal position.According to our predefined goal,19 screws （26％） were implanted inaccurately.In 10 cases the screw length was selected incorrectly：1 （1％） screw was too long and 9 （13％） were too short.No clinical signs of neurovascular lesion were observed.Learning curve was insignificantly noticeable （P=0.129）.Conclusion：In our study,the procedure of manufacturing and applying multi-level drill guide templates has a 26％ chance of screw misplacement.However,that rate does not coincide with pedicle perforation incidence and neurovascular injury.These facts along with a comparison to compatible studies make it possible to summarize that multi-level templates are satisfactorily accurate and allow precise screw placement with a clinically irrelevant mistake factor.Therefore templates could potentially represent a useful tool for routine pedicle screw placement.
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