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Surgical Technology International XXVIII contains peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
April, 2016- ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions.
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Neuro and Spine Surgery
A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain
Julio J. Jauregui, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Jeffrey J. Cherian, DO, Resident, Orthopaedic Surgery Department, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, Chukwuweike U. Gwam, MD, Research Assistant, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Morad Chughtai, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Jaydev B. Mistry, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Randa K. Elmallah, MD, Research Fellow, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Steven F. Harwin, MD, Chief, Adult Reconstruction Service, Mount Sinai Beth Israel, New York, New York, Anil Bhave, PT, Physical Therapist, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, Michael A. Mont, MD, Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Objective: Transcutaneous electrical nerve stimulation (TENS) may provide a safe alternative to current side-effect-heavy narcotics and anti-inflammatories utilized in chronic low back pain. Therefore, we performed a meta-analysis to evaluate the efficacy of TENS for the treatment of chronic low back pain.
Materials and Methods: We included randomized controlled trials (RCTs), cohort studies, and randomized crossover studies on TENS for the management of low back pain. We utilized a visual analogue scale (VAS) for pain as our primary outcome. Effectiveness of treatment was quantified using improvement in outcome scores for each study. Of the studies that met the criteria, 13 allowed for calculation of weighted mean differences in pain reduction. We used a random model effect to evaluate changes in pain produced by the intervention.
Results: Included were nine level I and four level II, encompassing 267 patients (39% male) who had a mean follow-up of seven weeks (range; 2 to 24 weeks). The mean duration of treatment was six weeks (range; 2 to 24 weeks). The standardized mean difference in pain from pre- to post-treatment for TENS was 0.844, which demonstrated significant improvement of TENS on pain reduction. When subdividing treatment duration, patients that were treated for < 5 weeks had significant effects on pain, while those treated for > 5 weeks did not.
Conclusion: Treatment of chronic low back pain with TENS demonstrated significant pain reduction. The application of TENS may lead to less pain medication usage and should be incorporated into the treatment armamentarium for chronic low back pain.
Percutaneous Pedicle Screw Fixation Technique in the Thoracic and Lumbar Spine—Tips and Tricks
Roberto Gazzeri, MD, Consultant Neurosurgeon, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy
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The need for spinal fixation in patients who cannot tolerate classical open surgery has led in recent years to the development of minimally invasive approaches. The use of percutaneous pedicle screw fixation offers several advantages, such as less blood loss and postoperative pain due to blunt separation of the muscles with reduction of soft tissue dissection. Medical records and demographic information, diagnosis, and preoperative pain levels of 63 patients who underwent percutaneous minimally invasive thoracolumbar spine stabilization using the Illico® Fixation System (Alphatec Spine, Carlsbad, California) were analysed: a total of 344 screws were implanted. Preoperative and postoperative clinical assessment of the patients were based on a visual analogue scale. Because percutaneous techniques do not allow gross visualization of the vertebra and erroneous placement of the screw may be high in the initial cases, we discuss the techniques for a safe implantation of pedicle screws using a single or double intraoperative fluoroscopy. We report tips and tricks for technical challenges including fixation in osteoporotic patients, percutaneous insertion of long rods, compression/distraction using multiaxial screws turning into monoaxial, and use of minimally invasive retractror for interbody fusion. Recently, indications for minimally invasive percutaneous fixation have expanded and my results support that it may be considered a safe and effective option for the treatment of degenerative and traumatic thoracolumbar spinal diseases.
Kenneth K. Hansraj MD, Chief of Spine Surgery, New York Spine Surgery & Rehabilitation Medicine, New York, New York, Attending Spine Surgeon, Mid-Hudson Regional Hospital, Westchester Medical Center Health Network, Poughkeepsie, New York
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Objective: It is a well-established fact that women who have large, heavy breasts suffer from spine pain. The objective of this study is to assess the forces that the breast exerts on the spine. It is important that such women understand the stresses that the spine is forced to sustain because of heavy breasts. Materials and Methods: The study was conducted using finite element analyses (FEA) of a human spine under different loads, loads being defined as incremental weights being sustained by the spine. The goal was to assess the influence of female breast size and weight on the forces and stresses sustained by the spine. Results: The magnitude of forces generated by the breast to the thoracic spine ranged between 8.5 pounds of force for underwire size 30 to 110 pounds of force for underwire size 60. All increments in between were assessed in Newton of force and pounds of force. Conclusion: The magnification factor of forces generated by breast weight is 10X. Using the American bra sizing system a woman with a breast size of 36H would expect 52 pounds of force on the spine (for both breasts) while with weight loss she might reduce her breast size to 36D, with a corresponding reduction of force to 28 pounds of both breasts; that is, a total stress reduction of 24 pounds to the spine. On the other hand, surgical enlargement of size 34B breasts (18.4 pounds) to 34F (32.1 pounds) leads to an increase of ~14 pounds of force on the spine.
