Everard Munting

How to Tango: a manual for implementing Spine Tango

The generic approach of the Spine Tango documentation system, which uses web-based technologies, is a necessity for reaching a maximum number of participants. This, in turn, reduces the potential for customising the Tango according to the individual needs of each user. However, a number of possibilities still exist for tailoring the data collection processes to the user’s own hospital workflow. One can choose between a purely paper-based set-up (with in-house scanning, data punching or mailing of forms to the data centre at the University of Bern) and completely paper-free online data entry. Many users work in a hybrid mode with online entry of surgical data and paper-based recording of the patients’ perspectives using the Core Outcome Measures Index (COMI) questionnaires. Preoperatively, patients can complete their questionnaires in the outpatient clinic at the time of taking the decision about surgery or simply at the time of hospitalisation. Postoperative administration of patient data can involve questionnaire completion in the outpatient clinic, the handing over the forms at the time of discharge for their mailing back to the hospital later, sending out of questionnaires by post with a stamped addressed envelope for their return or, in exceptional circumstances, conducting telephone interviews. Eurospine encourages documentation of patient-based information before the hospitalisation period and surgeon-based information both before and during hospitalisation; both patient and surgeon data should be acquired for at least one follow-up, at a minimum of three to six months after surgery. In addition, all complications that occur after discharge, and their consequences should be recorded.

Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects

Indications for correction of post-traumatic kyphotic deformity of the spine and technical aspects of the surgical procedure are reviewed. Surgical correction of post-traumatic deformity of the spine should be considered in patients presenting a local excess of kyphosis in the fractured area superior to 20° with poor functional tolerance. Severe pain, explained by objective factors such as canal or neuroforamen compromise with or without peripheral symptoms, angular deformity, non-union, focal instability, adjacent painful compensatory deformity such as lumbar hyper-lordosis or thoracic hypo-kyphosis or lordosis is a further argument for surgery. More advanced age, litigation, work-related trauma are negative factors. Planning of the surgical procedure includes the choice of the approach(es), the corrective means: subtraction osteotomy or vertebral body reconstruction and the nature and extent of osteosynthesis and fusion. Decision-making factors includes: level of trauma, severity of deformity, history of previous surgery in the area of deformity, bone quality, age of fracture. Corrective surgery of a post-traumatic deformity of the spine is a difficult procedure that should be considered only by an experienced team, after careful consideration of the indication and with the consent of a well-informed patient. Complications do occur and lead to the need of re-intervention in up to 10% of our cases. However, significant complications with lasting consequences did not occur in our experience. The more severe is the deformity, the better are the chances to improve the patient, as long as the surgical goals are fulfilled.

Vertebral reconstruction with cortical allograft: long-term evaluation.

Abstract. Reconstruction of large anterior vertebral column defects is indicated in a number of pathological conditions including tumor, infection, trauma and post-traumatic deformity. Several substitutes and techniques are available for the functional restoration of the vertebral column. Vascularized bone transfers, autografts, allografts or xenografts have been used, as well as metal or ceramic implants. All of these bear potential advantages and drawbacks in terms of associated morbidity of graft harvesting, disease transmission, mechanical failure, implant incorporation and overall long-term clinical outcome. In the present paper we report our experience with the use of freeze-dried, gamma-irradiated, cortical allograft for the reconstruction of large, anterior segmental defects of the spine, involving at least one vertebral body with its two adjacent discs. Cortical allografts were used in 67 cases operated for a variety of conditions. No case of disease transmission, infection or long-term mechanical graft failure occurred in our entire series, with a mean follow-up of 31 months. Fusion and mechanical stability was reliably obtained. Specific advantages include the absence of donor site morbidity, the possibilities for exact trimming to the size of the defect, superior mechanical strength as compared to available autograft, and reliable fusion with the host bone with partial bone remodeling, preventing fatigue failure. We conclude that freeze-dried, irradiated cortical allografts are safe and effective for anterior reconstruction of the spine.

Spine Tango annual report 2012.

Purpose Since the Spine Tango registry was founded over a decade ago it has become established internationally. An annual report has been produced using the same format as the SWEspine group to allow for first data comparisons between the two registries.MethodsData was captured with the latest generation of surgery and follow-up forms. Also, the Core Outcome Measures Index (COMI) from interventions performed in the year 2012 with follow-up to June 2013 was analyzed. Groups of patients with the most common degenerative lumbar spine diseases and a single group of patients with degenerative cervical spine diseases were created. The demographics, risk factors, previous treatments, current treatment, short-term outcomes, patient satisfaction and complications were analyzed. Pre- and postoperative pain and function scores were derived from the COMI.ResultsAbout 6,500 procedures were captured with Spine Tango in 2012. The definitions and composition of all the degenerative groups could not completely be matched between the two registries with the consequence that the age and sex distributions were partially different. Preoperative pain levels were similar. The short-term outcomes available did not allow for evaluation of the final result of surgical intervention. This will be possible with the longer term data in the next annual report. There was a distinct disparity in reported complication rates between surgeons and patients.ConclusionsThis is a valuable first step in creating comparable reports for SWEspine and Spine Tango. The German spine registry may be able to collaborate in the future because of similar items and data structure as Spine Tango. There needs to be more work on understanding the harmonization of the different degenerative subgroups. The Spine Tango report is weakened by the short and incomplete follow-up. The visual presentation of data may be a useful model for aiding decision making for surgeons and patients in the future.