Úvod: Kvalita ošetření zlomenin páteře s neurologickým postižením spočívá ve volbě správné operační strategie, ve správném načasování její realizace a ve správném technickém provedení. Selhání kterékoliv z uvedených složek ošetření výrazně negativně ovlivňuje další péči o zraněného. Korektnost technického provedení je v řadě případů velmi sporná. Je třeba věnovat pozornost zdokonalení techniky použití spinálních implantátů, aby mohla postakutní i chronická fáze péče o pacienty s neurologickým postižením probíhat nerušeně. Materiál a metoda: Retrospektivní analýza kvality primárního chirurgického ošetření pacientů s traumatickou míšní lézí hospitalizovaných na spinální jednotce Krajské nemocnice Liberec v letech 2003–2012 a na spinální jednotce FN v Motole v letech 2004–2012. Výsledky: V průběhu sledovaného období bylo nevhodné ošetření zjištěno u 191 pacientů ze 775 (24,6 %). V suboptimálním ošetření dominovala chybná repozice u 111 případů (58,1 %) a chybné zavedení pedikulárních šroubů v 78 případech (48,8 %). Následovala chybná dekomprese v 52 případech (27,2 %). U 85 pacientů (44,5 %) bylo nutné kompletní přepracování stabilizace. Nebyl zaznamenán žádný vývoj v počtu nesprávně ošetřených pacientů v jednotlivých letech. U suboptimálně ošetřených pacientů s poraněním v krční, hrudní i bederní oblasti se shodně prodloužila hospitalizace v průměru o 9,58 dne. Závěr: Autoři doporučují důsledné dodržování operační techniky a kritické pooperační rentgenové kontroly. Další pokrok spatřují v kvalitním vzdělávacím systému ve spondylochirurgii.
Introduction: Right surgical strategy, optimal timing and correct surgical technique are crucial for the quality of treatment of spinal fractures associated with neurological deficit. Failure of any of these parts of treatment has an immensely negative effect on subsequent patient care. In many cases, the quality of technical performance of the surgery is controversial. It is desirable to improve the use of spinal implants to achieve undisturbed course of subacute and chronic phases of treatment. Material and methods: Retrospective analysis of the quality of primary surgical treatment of patients with posttraumatic spinal cord injury treated at the Spinal Unit of the Regional Hospital Liberec between 2003 and 2012 and at the Spinal Unit of the University Hospital Motol in Prague between 2004 and 2012. Results: Incorrect surgical treatment was delivered in 191 of 775 cases (24.6%). Wrong fracture reduction was preformed in 111 cases (58.1%). Incorrect pedicle screw insertion was found in 78 cases, followed by insufficient decompression of the spinal channel in 52 cases. A revision surgery with complete reinstrumentation was required in 85 patients (44.5%). We identified no development in the number of suboptimally treated patients over the analyzed years. The length of hospital stay in suboptimally treated patients was prolonged by the mean of 9.58 days. Conclusion: The authors recommend strict compliance with the surgical technique and rigorous post-operative X-ray follow ups. This field could further be improved with high-quality spinal surgery educational system. Key words: spinal cord injury – spinal cord decompression – spinal fracture reduction – spine stabilization The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Keywords
- dekomprese míchy, stabilizace páteře, repozice zlomenin páteře,
- MeSH
- Lumbar Vertebrae surgery injuries MeSH
- Decompression, Surgical methods adverse effects statistics & numerical data MeSH
- Medical Errors * statistics & numerical data adverse effects MeSH
- Length of Stay statistics & numerical data MeSH
- Adult MeSH
- Spinal Fractures surgery MeSH
- Spinal Fusion adverse effects MeSH
- Thoracic Vertebrae surgery injuries MeSH
- Internal Fixators adverse effects MeSH
- Bone Screws statistics & numerical data adverse effects MeSH
- Cervical Vertebrae surgery injuries MeSH
- Humans MeSH
- Manipulation, Orthopedic adverse effects MeSH
- Pedicle Screws MeSH
- Postoperative Complications MeSH
- Spinal Cord Injuries * etiology surgery MeSH
- Reoperation statistics & numerical data MeSH
- Retrospective Studies MeSH
- Quality Control MeSH
- Fracture Fixation, Internal adverse effects MeSH
- Outcome and Process Assessment, Health Care * statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Multicenter Study MeSH
Cervical total disc replacement (CTDR) aims to decrease the incidence of adjacent segment disease through motion preservation in the operated disc space. Ongoing data collection and increasing number of studies describing heterotopic ossification (HO) resulting in decreased mobility of implants, forced us to carefully evaluate our long-term clinical and morphological results of patients with CTDR. We present the first 54 consecutive patients treated with 65 ProdiscC prostheses during a 12-month period (2/2004-3/2005). All patients signed an informed consent and were included in prospective long-term study approved by hospital ethical committee. The 1- and 2-year follow-up analysis were available for all patients included and 4-year results for 50 patients (60 implants). Clinical (neck disability index-NDI, visual analog scale-VAS) and radiological follow-up was conducted at 1-, 2- and 4-years after the procedure. The Mehren/Suchomel modification of McAfee scale was used to classify the appearance of HO. Mean preoperative NDI was 34.5%, VAS for neck pain intensity 4.6 and VAS for arm pain intensity 5.0. At 1-, 2- and 4-year follow-up, the mean NDI was 30.7, 27.2, and 30.4, mean VAS for neck pain intensity 2.5, 2.1 and 2.9 and mean VAS for arm pain intensity pain 2.2, 1.9 and 2.3, respectively. Significant HO (grade III) was present in 45% of implants and segmental ankylosis (grade IV) in another 18% 4 years after intervention. This finding had no clinical consequences and 92% of patients would undergo the same surgery again. Our clinical results (NDI, VAS) are comparable with fusion techniques. Although, advanced non-fusion technology is used, a significant frequency of HO formation and spontaneous fusion in cervical disc replacement surgery must be anticipated during long-term follow-up.
- MeSH
- Ankylosis etiology pathology physiopathology MeSH
- Neck Pain etiology pathology physiopathology MeSH
- Time MeSH
- Time Factors MeSH
- Diskectomy adverse effects MeSH
- Adult MeSH
- Spinal Fusion adverse effects MeSH
- Ossification, Heterotopic etiology pathology physiopathology MeSH
- Head Movements physiology MeSH
- Internal Fixators adverse effects MeSH
- Cervical Vertebrae pathology surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Stress, Mechanical MeSH
- Pain Measurement MeSH
- Follow-Up Studies MeSH
- Postoperative Complications etiology pathology physiopathology MeSH
- Disability Evaluation MeSH
- Recurrence MeSH
- Range of Motion, Articular physiology MeSH
- Intervertebral Disc Displacement complications pathology surgery MeSH
- Weight-Bearing physiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Electric Conductivity adverse effects MeSH
- Fracture Healing * physiology MeSH
- Internal Fixators * adverse effects MeSH
- Conductometry methods instrumentation MeSH
- Rabbits MeSH
- Models, Animal MeSH
- Guinea Pigs MeSH
- Dogs MeSH
- Fracture Fixation, Internal * methods adverse effects MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Guinea Pigs MeSH
- Dogs MeSH
- Animals MeSH
