J. N. Alastair Gibson

Decompression and paraspinous tension band: a novel treatment method for patients with lumbar spinal stenosis and degenerative spondylolisthesis.

BACKGROUND CONTEXT Prior studies have demonstrated the superiority of decompression and fusion over decompression alone for the treatment of lumbar degenerative spondylolisthesis with spinal stenosis. More recent studies have investigated whether nonfusion stabilization could provide durable clinical improvement after decompression and fusion. PURPOSE To examine the clinical safety and effectiveness of decompression and implantation of a novel flexion restricting paraspinous tension band (PTB) for patients with degenerative spondylolisthesis. STUDY DESIGN A prospective clinical study. PATIENT SAMPLE Forty-one patients (7 men and 34 women) aged 45 to 83 years (68.2 ± 9.0) were recruited with symptomatic spinal stenosis and Meyerding Grade 1 or 2 degenerative spondylolisthesis at L3-L4 (8) or L4-L5 (33). OUTCOME MEASURES Self-reported measures included visual analog scale (VAS) for leg, back, and hip pain and the Oswestry Disability Index (ODI). Physiologic measures included quantitative and qualitative radiographic analysis performed by an independent core laboratory. METHODS Patients with lumbar degenerative spondylolisthesis and stenosis were prospectively enrolled at four European spine centers with independent monitoring of data. Clinical and radiographic outcome data collected preoperatively were compared with data collected at 3, 6, 12, and 24 months after surgery. This study was sponsored by the PTB manufacturer (Simpirica Spine, Inc., San Carlos, CA, USA), including institutional research support grants to the participating centers totaling approximately US

Multi-level spine endoscopy

172,000. RESULTS Statistically significant improvements and clinically important effect sizes were seen for all pain and disability measurements. At 24 months follow-up, ODI scores were reduced by an average of 25.4 points (59%) and maximum leg pain on VAS by 48.1 mm (65%). Back pain VAS scores improved from 54.1 by an average of 28.5 points (53%). There was one postoperative wound infection (2.4%) and an overall reoperation rate of 12%. Eighty-two percent patients available for 24 months follow-up with a PTB in situ had a reduction in ODI of greater than 15 points and 74% had a reduction in maximum leg pain VAS of greater than 20 mm. According to Odom criteria, most of these patients (82%) had an excellent or good outcome with all except one patient satisfied with surgery. As measured by the independent core laboratory, there was no significant increase in spondylolisthesis, segmental flexion-extension range of motion, or translation and no loss of lordosis in the patients with PTB at the 2 years follow-up. CONCLUSIONS Patients with degenerative spondylolisthesis and spinal stenosis treated with decompression and PTB demonstrated no progressive instability at 2 years follow-up. Excellent/good outcomes and significant improvements in patient-reported pain and disability scores were still observed at 2 years, with no evidence of implant failure or migration. Further study of this treatment method is warranted to validate these findings.

Long-term effects of patellectomy on quadriceps and hamstring isokinetic function

In the last ten years, there has been an exponential increase in endoscopic spinal surgery practice. With improvements in equipment quality and the availability of high definition camera systems, cervical endoscopic disc resection is now a viable alternative to anterior cervical decompression and fusion (ACDF) or disc arthroplasty for the treatment of disc prolapse and low grade stenosis. Based on the current literature, there is now strong evidence to support the use of transforaminal endoscopic approaches for the treatment of thoracic disc prolapse. There is now level I evidence to show that outcomes following transforaminal endoscopic discectomy (TED) are at least equivalent to those after open microdiscectomy, with an expected shorter operating time, lesser requirement for analgesia, reduced duration of post-operative disability, more rapid rehabilitation and lower costs of care. However, it should be recognised that there is a significant learning curve for TED. New endoscopic techniques with interlaminar approaches allow the decompression of central and lateral recess stenosis. Future developments will facilitate vision and access to the spine with 3D imaging and robotics at the forefront. We present a case report of whole spine endoscopic decompression to illustrate the potential of endoscopic surgery at all spinal levels. Cite this article: EFORT Open Rev 2017;2:317-323. DOI: 10.1302/2058-5241.2.160087

Cervical endoscopic spinal surgery: A review of the current literature:

Summary Diminution in thigh muscle contractile power occurs following surgical excision of the patella and reconstruction of the quadriceps mechanism. In order to quantify residual functional losses several years after patellectomy, we have measured the force-velocity relationships of concentric and eccentric quadriceps and hamstring muscle contractions using a Kin-Com isokinetic dynamometer, comparing the results to those from the contralateral (disease-free) leg. After a mean period of seven years, quadriceps isometric forces (-30 ± 14% at 30° flexion and −21 ± 14% at 90° flexion, means ± SD, p −1 : normal 105 ± 45 Nm, patellectomy 70 ± 44 Nm, p

Is surgery more effective than nonsurgical treatment for the management of patients with degenerative spondylolisthesis

Cervical endoscopic spinal surgery (CESS) is now regularly performed in some centres in the Far East, yet rarely in Europe and the United States. This review describes the application of CESS through anterior and posterior approaches with analysis of the available evidence supporting current techniques. An electronic literature search identified 52 papers and proceedings’ abstracts of which 25 (16 anterior approach and 9 posterior approach) provided comparable clinical outcomes. The results revealed a good or excellent outcome from CESS in 91% (range 74–100%) with a complication rate of 5%. In a local cohort study, patients had 72% less neck pain (visual analogue scale rating) and 81% less arm pain at 6 months when CESS was used as an isolated procedure, and 74% less neck pain and 83% less arm pain when coupled with disc replacement or fusion at an adjacent level.

Creation of an ovine model of progressive structural lordo-scoliosis using a unilateral laminar tether

Is surgery more effective than nonsurgical treatment for the management of patients with degenerative spondylolisthesis?