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

2. 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

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

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

5. 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

6. 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)

7. 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 %

8. 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

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

10. 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

11. 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.

12. 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

13. 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

14. Radiological images

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

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

19. 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%

20. Gender distribution

23. 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

24. 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

25. 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

26. 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.

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

28. THE END