OUTCOME OF SPINE SURGERY IN ELDORET Dr.L.K.Lelei Specialist Orthopaedic Surgeon Moi University, Eldoret

Normal functions of the spine Protect spinal cord and nerves Support the body weight and external load Allow motion of the body for various activities

Spinal Disorders Trauma Tumors Infection and inflammatory diseases Deformity (scoliosis, sponylolithesis) Cervical and low back pain ( degenerative disease e.g. disc herniation, stenosis)

Treatment of Spinal disorders Conservative treatment Degenerative disease Stable fracture Mild deformity Surgical treatment Failed conservative treatment Unstable fracture (dislocation) Progressive deformity

Goals of Spine Surgery Relieve pain by eliminating the source of problems (decompression) Stabilize the spinal segments after decompression Restore the structural integrity of the spine (almost normal mechanical function of the spine) Maintain the correction Prevent the progression of deformity of the spine

Significant Indicators in Spine Surgery History Age (<18yrs, >55yrs) History of trauma Pain (radicular, nocturnal unremitting) Drug history (use of steroids) Examination Spine (structural deformity, pain in motion) Neurological (myeloradiculopathy)

Spinal Fusion Elimination of segmental movement across an intervertebral segment by bone union One of the most commonly performed, yet incompletely understood procedures in spine surgery Non-union rate: 5 to 35 %

Spinal fusion cont’ Ultimate goal is the elimination of pathologic segmental motion and its accompanying symptoms. Achieved by formation of ossesous bridging across previously mobile level. 3 basic requirements for successful fusion: Immobilization Fusion bed Bone graft

Indications for spinal fusion Degenerative spondylolisthesis Spinal stenosis Lumbar spondylosis Intervertebral disc herniation Spinal deformity Spinal trauma Oncologic conditions

Factors for Consideration in Spine Fusion Biologic Factors Local Factors: Soft tissue bed, Graft recipient site preparation, Radiation, Tumor and bone disease, Growth factors. Systematic Factors: Osteoporosis, Hormones, Nutrition, Drugs, Smoking Graft Factors Material, Mechanical strength, Size, Location Biomechanical Factors Stability, Loading

Types of fusion Interbody fusion Posterolateral fusion Removal of intervertebral disc and replacement with bone graft and/or a device (spacer or cage) to maintain alignment and disc height. Posterolateral fusion Places the bone graft between the transverse processes.

Spinal Instrumentation Goals of Spinal Instrumentation: Correction of deformities or misaligned segments; Enhancement of solid fusion; Maintain anatomic alignment until a solid fusion takes place; and Allow early mobilization of patients Provides immediate stability

Consideration Factors in Spinal Instrumentation Materials: Bio-compatibility and Imaging compatibility Stiffness (or elasticity) and strength Corrosion Implant Strength: Component (screw, rod, plate, wire, etc.) strength Metal-metal interface strength Construct strength Bone-metal interface strength: Bone–wire, -hook, and -screws Construct Stability: Segmental stiffness or flexibility

Radiological images

Complications Nerve root injury Incidental durotomy Wrong level surgery Adjacent level disease Graft retropulsion and pseudoarthrosis in instrumentation

Results 86 patients done spine surgery between January 2014 and December 2015. Mean age of 52.3 years. Range of 18 years to 80 years old. Spinal stenosis was the leading indication for surgery

Cont’ Pain in the hip region and the lower limbs was the chief complain Decompression with posterior instrumented fusion was done in majority of the patients. On follow up, the mean Oswestry disability index was 16.3%

Gender distribution

Levels of spinal fusion (N=36) Spine Level Total Percentage L2-S1 10 27.8 L3-L5 9 25.0 L3-S1 8 22.1 L2-L5 5 13.9 T3-T5 1 2.8 T11-L3 T6/7-T12/L1 C5-C6 36 100

Oswestry disability index scoring (N=65) Score Interpretation Total Percentage 0-20% Minimal disability 47 72.3 21-40% Moderate disability 14 21.5 41-60% Severe disability 4 6.2 61-80% Crippled 0.0 81-100% Bed bound or exaggerated symptoms

Discussion Incidence of chronic lower back pain has been on the increase. Commonest cause of disability Spinal stenosis and spondylolithesis are among the leading indications for spine surgery. Decompression surgery for spinal stenosis mainly attributed to a growing ageing population

Discussion Spinal fusion is a procedure performed as an adjunct in the surgical management of patients with degenerative spinal disease and instability Present study showed significant functional improvement in patients done spinal fusion Significant correlation between radiological evaluation of fusion and functional outcome.

Cont’ Marked improvement in patient outcome following spine surgery patient perceived recovery functional disability pain.

THE END