AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an onli...AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.RESULTS: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.展开更多
Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TL...Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TLIF), Lateral lumbar interbody fusion (LLIF) and Anterior lumbar interbody fusion (ALIF). Successful lumbar fusion is associated with better clinical outcomes, and it is enhanced and targeted through the use of bone graft materials as an osteogenic cell binding peptide P-15, bound to an anorganic bone mineral (ABM). This peptide improves bone formation when used in fixation devices in a targeted and limited way to the implant surface by activating osteoblast precursor cells;by the osteogenic, osteoinductive and osteoconductive stimuli. The main objective of this study is to standardize the lumbar fusion process in the 3 techniques and achieve a more efficient and predictable lumbar fusion, evaluating results with radiological and clinical scales. Material and Methods: Patients underwent lumbar fusion with the use of P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (P-15/ABM) bone graft (5 cc) in three different techniques (TLIF, LLIF, ALIF), achieving a total of 100 lumbar levels. Radiological outcomes included fusion rates per Hounsfield Units at computed tomography (CT) scan and Lenke scale. Clinical outcomes were evaluated via the Oswestry Disability Index (ODI), Short Form Performance (SPF-36) and Visual Analog Scale (VAS and VASs) for pain and satisfaction. Results: 67 patients completed the 12 months follow-up, showing no differences in fusion rates between techniques. (Computed Tomography Hounsfield Units) CTHU reaches more than 200 UH at 3 months follow-up and continues fusion process till 12-month follow-up. Clinical scales showed no disability at ODI, improvement at VAS and VASs scales, absence of health restrictions at SPF-36 score since 6 months follow up. Conclusion: Bone graft volume of 5 cc is adequate for achieving successful lumbar fusion, regardless of the surgical technique employed.展开更多
Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the curre...Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioningon the operating table, release maneuvers, type of instrumentation used(rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.展开更多
AIM: To review the results of our experience with the Medartis Aptus plating system for four corner arthrodesis of the wrist, which uses a combination of compression screws and variable angle locking screws.METHODS: W...AIM: To review the results of our experience with the Medartis Aptus plating system for four corner arthrodesis of the wrist, which uses a combination of compression screws and variable angle locking screws.METHODS: We reviewed the results of 17 procedures in 16 patients that underwent scaphoid excision and four corner fusion using the Medartis Aptus system between May 2010 and June 2014. The primary outcome measure was radiographic and clinical union. RESULTS: The mean clinical follow up time was 20.6 mo. The mean union time was 6 mo. Two non-unions required revision procedures. The mean disabilities of the arm, shoulder and hand score taken after union was 36. The mean final grip strength was 27 kg. The mean final range of movement was 30° flexion and 31° of extension. All patients had a restored scapholunate angle on postoperative radiographs. There were no incidences of dorsal impingement.CONCLUSION: Overall our experience with the Aptus plating system shows comparable results to other methods of fixation for four corner fusion, in the short to medium term.展开更多
The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on informati...The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on information fusion strategies to enhance its recognition power. The system was implemented using RFID technology. It monitored the presence of surgical tools in the interventional site and the instrument tray and combined the measured information by applying redundant, complementary, and cooperative information fusion strategy to achieve a more comprehensive model of the current situation. An evaluation study was performed that showed a correct classification rate of 97% for the system.展开更多
文摘AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.RESULTS: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.
文摘Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TLIF), Lateral lumbar interbody fusion (LLIF) and Anterior lumbar interbody fusion (ALIF). Successful lumbar fusion is associated with better clinical outcomes, and it is enhanced and targeted through the use of bone graft materials as an osteogenic cell binding peptide P-15, bound to an anorganic bone mineral (ABM). This peptide improves bone formation when used in fixation devices in a targeted and limited way to the implant surface by activating osteoblast precursor cells;by the osteogenic, osteoinductive and osteoconductive stimuli. The main objective of this study is to standardize the lumbar fusion process in the 3 techniques and achieve a more efficient and predictable lumbar fusion, evaluating results with radiological and clinical scales. Material and Methods: Patients underwent lumbar fusion with the use of P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (P-15/ABM) bone graft (5 cc) in three different techniques (TLIF, LLIF, ALIF), achieving a total of 100 lumbar levels. Radiological outcomes included fusion rates per Hounsfield Units at computed tomography (CT) scan and Lenke scale. Clinical outcomes were evaluated via the Oswestry Disability Index (ODI), Short Form Performance (SPF-36) and Visual Analog Scale (VAS and VASs) for pain and satisfaction. Results: 67 patients completed the 12 months follow-up, showing no differences in fusion rates between techniques. (Computed Tomography Hounsfield Units) CTHU reaches more than 200 UH at 3 months follow-up and continues fusion process till 12-month follow-up. Clinical scales showed no disability at ODI, improvement at VAS and VASs scales, absence of health restrictions at SPF-36 score since 6 months follow up. Conclusion: Bone graft volume of 5 cc is adequate for achieving successful lumbar fusion, regardless of the surgical technique employed.
文摘Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioningon the operating table, release maneuvers, type of instrumentation used(rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.
文摘AIM: To review the results of our experience with the Medartis Aptus plating system for four corner arthrodesis of the wrist, which uses a combination of compression screws and variable angle locking screws.METHODS: We reviewed the results of 17 procedures in 16 patients that underwent scaphoid excision and four corner fusion using the Medartis Aptus system between May 2010 and June 2014. The primary outcome measure was radiographic and clinical union. RESULTS: The mean clinical follow up time was 20.6 mo. The mean union time was 6 mo. Two non-unions required revision procedures. The mean disabilities of the arm, shoulder and hand score taken after union was 36. The mean final grip strength was 27 kg. The mean final range of movement was 30° flexion and 31° of extension. All patients had a restored scapholunate angle on postoperative radiographs. There were no incidences of dorsal impingement.CONCLUSION: Overall our experience with the Aptus plating system shows comparable results to other methods of fixation for four corner fusion, in the short to medium term.
文摘The recognition of surgical processes in the operating room is an emerging research field in medical engineering. We present the design and implementation of a instrument localization system that is based on information fusion strategies to enhance its recognition power. The system was implemented using RFID technology. It monitored the presence of surgical tools in the interventional site and the instrument tray and combined the measured information by applying redundant, complementary, and cooperative information fusion strategy to achieve a more comprehensive model of the current situation. An evaluation study was performed that showed a correct classification rate of 97% for the system.
