Narrow Results

Posterior interspinous dynamic stabilization is used increasingly in the treatment of lumbar degenerative spinal conditions, with preliminary evidence for its clinical and biomechanical efficacy emerging. The need remains to define patients who respond best to this form of surgery. This study examined clinical outcomes in 39 patients (21 females) with defined lumbar spinal pathologies, for two years after lumbar surgery augmented with the Device for Intervertebral Assisted Motion (DIAM). Anatomical patient categorization revealed involvement of disc (n=25/39) and facet (n=14/39) lumbar pathology, with clinical indications for surgery being: segmental instability (n=21/39); nerve root compression (n=11/39); and facet joint pain syndrome (n=7/39). Pain, function and satisfaction data were derived from MODEMS self-report questionnaires, which were collected prospectively over a two-year post-operative period. Results showed that L4-5 and L5-S1 were the most common DIAM-implanted spinal levels. Clinically significant post-operative improvement in pain (23.4%) and function (13.5%) occurred between three and twenty-four months. Eleven (of 39) required further lumbar surgery. Nineteen (of 28) were more satisfied at 24 months post-operatively compared to baseline. Disc involvement and segmental instability were the most common presenting lumbar segmental pathologies, yet the least successful in response to surgery augmented with DIAM. Patients with facet involvement reported superior improvement post-operatively compared with those with disc involvement. Patients with facet joint disease demonstrate better outcomes at 24 months following lumbar surgery augmented with DIAM posterior interspinous dynamic stabilization, compared with those presenting with disc pathology.

Purpose: To examine clinical outcomes after decompressive lumbar surgery for herniated nucleus pulposus (HNP) in two cohorts from a single surgeon: Microdiscectomy alone [MICRO] versus microdiscectomy augmented with the Device for Intervertebral Assisted Motion [DIAM™, Medtronic Sofamor Danek, Memphis, USA]. We hypothesized that DIAM-augmented microdiscectomy would provide superior outcomes to microdiscectomy alone given purported benefits for interspinous devices reported in the literature. Improvements would concur with clinically significant change. Methods: Two separate HNP patient groups were sourced from a single surgeon: MICRO [n = 47 (17F/30M); 45 years (SD 14.2; 22–75)] and DIAM [n = 29 (10F/19M); 42 years (SD 11.2; 20–64)]. Patient-reported outcomes for function [MICRO=Roland-Morris Questionnaire (RMQ); DIAM=Oswestry Disability Index (ODI)] and back and leg pain [visual analogue scale (VAS)] were serially examined at preoperative baseline, 4–6 weeks, 6 and 12 months postoperatively. Incidence of repeat surgery at the index segment was recorded. Data were reported using descriptive statistics, unpaired t-tests and repeated ANOVA (Scheffe's post-hoc test). Statistically meaningful differences were defined by p < 0.05. Results: MICRO cases had higher preoperative leg pain (by 19%; p < 0.01). Improvements in absolute function and leg pain at one year were better in the MICRO group (p < 0.01). Both groups showed clinically significant improvement for all variables at each time-point during the period of follow-up. MICRO cases had proportionally fewer repeat surgeries (3/47 versus 4/29). Conclusions: Significant improvements in function, back and leg pain were shown in both patient groups out to one year. Clinically important change to function, back and leg pain was achieved for the MICRO cases, while clinically important change to leg pain occurred in the DIAM group. MICRO cases required proportionally fewer repeat surgeries by one year postoperatively. Microdiscectomy augmented with DIAM did not result in superior outcomes in treatment of herniated nucleus pulposus compared with microdiscectomy alone.

The aim of this study was to retrospectively review clinical outcomes of posterolateral fusion for 50 consecutive patients with unstable lumbar spine and to determine which radiological factors affect clinical results. Patients with poor outcomes were older and had a greater number of fused segments than did those with good outcomes. Except for these, there were no relationships between clinical preoperative factors and outcomes on follow-up examination. At follow-up, decrease in lordosis and increases in slippage and L1 axis S1 distance (LASD) (which was measured as the distance along the perpendicular axis from the center in the L1 body to the posterior superior edge of the S1 body) were found in patients with poor surgical outcomes. The slippage on follow-up examination was significantly greater in patients with LASDs above 35 mm, preoperatively, than in those whose LASD was less than 35 mm. The lesions of adjacent segments and bony union rate did not influence the clinical results. A preoperative radiological risk factor is LASD greater than 35 mm, which was associated with an increase in the slippage at follow-up. Maintenance of lumbar lordosis and an LASD below 35 mm and after the surgery, may improve clinical outcomes.

A matter of the heart.

Discovering opportunities in China’s cardiovascular market.

Improving outcomes and expanding indications with Transcatheter Aortic Valve Implantation (TAVI).

Community-based cardiac rehabilitation in Singapore.

The gift of life: 50 years of human heart transplant.

How to make value-based care a reality?

Impactful interventions to maximise healthspan.

Viral hepatitis in Arkhangai: How Asia’s first micro-treatment program’s successes can be leveraged to treat a “silent killer”.

The long-suffering challenge of vaccination.