Spondylodiscitis instrumented fusion, a prospective case series on a standardized neurosurgical protocol with long term follow up

Open laminectomy plus posterolateral fusion versus open laminectomy plus transforaminal lumbar interbody fusion surgical approaches for fusing degenerated L4-L5 segment: A comparative finite element study

Various finite element (FE) studies reported the biomechanical effects of fusion surgeries in the lumbar spine. However, a comparative study on Open laminectomy plus Posterolateral Fusion (OL-PLF) and Open Laminectomy plus Transforaminal Lumbar Interbody Fusion (OL-TLIF) for fusing an L4-L5 segment has not been reported in the literature. The present comparative FE study evaluates the biomechanical variations in an L4-L5 segment fused using OL-PLF and OL-TLIF surgical approaches. The three-dimensional implanted models were constructed from a computed-tomography scan dataset using image processing software. The models were simulated for the physiological movements such as lateral bending, flexion and extension. The OL-TLIF model had a considerably larger peak equivalent strain than the OL-PLF model under extension (126 %), lateral bending (88 %) and flexion (13 %). However, in both implanted models, a peak equivalent strain above the compressive yield strain limit of the vertebra (0.007) was observed over 60 % of the L4-L5 fused segment, indicating an imminent post-operative bone failure under the imposed loading conditions. The maximum equivalent strain observed in the disc and endplates of the L3-L4 segment was substantially larger to initiate the adjacent segment degeneration. No discernible biomechanical benefits were observed for the OL-TLIF or OL-PLF approaches in fusing the L4-L5 segment.

Spondylodiscitis Following Perforated Acute Appendicitis: A Case Report

Spondylodiscitis is a multifactorial disease of significant medical and socioeconomic importance, the treatment of which presents a challenge to clinicians and surgeons. Acute appendicitis is a common inflammatory disease in children, with postoperative complications occurring in up to 55% of cases. We present the case of a 15-year-old male with symptoms of severe back pain and fever two months following surgery for perforated appendicitis. The computed tomography (CT) revealed spondylodiscitis of T12-L1 spinal level. Discectomy and posterior pedicle-screw fixation were performed, followed by antibiotic treatment resulted in the resolution of preoperative symptoms. To the best of our knowledge, this is the third case of spondylodiscitis after perforated acute appendicitis in literature. Timely diagnosis and treatment in cases of spondylodiscitis are prerequisites for lowering the rate of permanent neurological deficits in these patients.

The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

BACKGROUND

The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims to stabilize the lumbar spine by fusing two or more vertebrae using an interbody cage. LIF is a standard treatment for various spinal conditions, such as degenerative disc disease, spinal stenosis, and spondylolisthesis. However, successful fusion is challenging for patients with osteoporosis due to their reduced bone mineral density (BMD) and increased risk of cage subsidence, which can lead to implant failure and poor clinical outcomes.

METHODS

 A comprehensive literature search yielded 220 articles, with 16 ultimately included. Keywords included BMD, cage subsidence, osteoporosis, teriparatide, and lumbar interbody fusion.

RESULTS

 This review examines the relationship between BMD and LIF success, emphasizing the importance of adequate bone quality for successful fusion. Preoperative assessment methods for BMD and the impact of low BMD on fusion rates and patient outcomes are discussed. Additionally, techniques to improve fusion success in patients with weakened bone density, such as biological enhancement and BMD-matched interbody cages, are explored. However, consensus on the exact BMD threshold for a successful outcome remains elusive.

CONCLUSION

 While an apparent correlation between BMD and fusion rate in LIF procedures is acknowledged, conclusive evidence regarding the precise BMD threshold indicative of an increased risk of unfavorable outcomes remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD. Furthermore, future research initiatives, particularly longitudinal studies, are encouraged to prioritize the examination of BMD as a fundamental risk factor, addressing gaps in the literature.