As an example of benchmarking in spinal surgery using Spine Tango, we extracted data on dural tears, one of the most frequent types of complications in posterior spinal fusion. Little is known about their predictors. This study examined which factors predict the occurrence of dural tears in posterior spinal fusion. Prospective consecutive documentation of hospital based interventions with an evidence level 2++. Between May 2005 and November 2006 data of 3437 patients were documented in the registry. Nine hundred and twenty nine patients, who had been treated with posterior spinal fusion after opening of the spinal canal, were included in this study. Dural tears being the most frequent type of complications in the registry were chosen as dependent outcome variable. Multiple linear regression with stepwise elimination was performed on potential predictor-variables of the occurrence of dural tears. Benchmarking compared the performance of single hospitals with international peers. Median age was 62.7 years (min 12.5, max 90.5 yrs) with a female to male ratio of 2:1. In 18 of 929 cases a dural tear occurred. Hospital (p=0.02) and number of segments of fusion (p=0.018) were found to be predictors of the occurrence of dural tears in posterior spinal fusion. Number of fusions per hospital (min 25, max 526) and academic status of hospital had no influence on the rate of dural tears. Fusions of four and more segments showed an increase of the rate of dural tears by a factor of three compared to fusions of less than four segments. There was no significant difference between fusions of one segment and fusions of two or three segments (1.3 vs. 1.9%) as well as between fusions of four or five segments and fusions of more than five segments (4.6 vs. 4.2%). Differences between hospitals remained when benchmarking dural tears with case mix. Predictors of dural tears in posterior spinal fusion are. hospital and. number of segments of fusion. In fusions of four and more segments a threefold higher risk of dural tears in comparison to fusions of less than four segments should be taken into consideration

Introduction: As an example of possibilities of Spine Tango we extracted data on dural tears, one of the most frequent types of complications in posterior spinal fusion. Little is known about their predictors. This study examined which factors predict the occurrence of dural tears in posterior spinal fusion. Methods: Prospective consecutive documentation of hospital based interventions with an evidence level 2++. Between 05/2005 and 11/2006 data of 3437 patients were documented in the registry. 929 patients, who had been treated with posterior spinal fusion after opening of the spinal canal, were included in this study. Median age was 62.7 yrs (min 12.5, max 90.5 yrs) with a female to male ratio of 2:1. In 18 of 929 cases a dural tear occurred. Dural tears being the most frequent type of complications in the registry were chosen as dependent outcome variable (3–6). Multiple linear regression with stepwise elimination was performed on potential predictor-variables of the occurrence of dural tears. Benchmarking compared the performance of single hospitals with international peers. Results: Hospital (p=0.02) and number of segments of fusion (p=0.018) were found to be predictors of the occurrence of dural tears in posterior spinal fusion. Number of fusions per hospital (min 25, max 526) and academic status of hospital had no influence on the rate of dural tears. Fusions of four and more segments showed an increase of the rate of dural tears by a factor of three compared to fusions of less than four segments. There was no significant difference between fusions of one segment and fusions of two or three segments (1.3 vs. 1.9%) as well as between fusions of four or five segments and fusions of more than five segments (4.6 vs. 4.2%). Differences between hospitals remained when benchmarking dural lesions with case mix. Discussion: The feasibility of data analysis and benchmarking from the International Spine Registry Spine Tango could be demonstrated. Predictors of dural tears in posterior spinal fusion are. hospital and. number of segments of fusion. In fusions of four and more segments a threefold higher risk of dural tears in comparison to fusions of less than four segments should be taken into consideration. A subgroup analysis on the predictor-variable hospital should be performed assessing further covariates. However, this goes beyond the possibilities of documentation in this international spine registry

Introduction: Dural tears are one of the most frequent type of complication in posterior spinal fusion with little known about their predictors. Method: Prospective consecutive study with an evidence level 2++ of 42 patients in the international spine registry Spine Tango, who had been treated between 05/2005 and 8/2008 with posterior spinal fusion after opening of the spinal canal. Median age was 62.7 yrs (min 12.5, max 90.5 yrs) with a female to male ratio of 2:1. In 42 of 1575 cases a dural tear occurred being the most frequent type of complication in our study sample. Multiple linear regression was performed on potential predictor-variables of the occurrence of dural tears. Results: Hospital (p=0.02) and number of segments of fusion (p=0.018) were found to be predictors of the occurrence of dural tears in posterior spinal fusion. Number of fusions per hospital (min 25, max 526) and academic status of hospital had no influence on the rate of dural tears. Fusions of four and more segments showed an increase of the rate of dural tears by three compared to fusions of less than four segments. Conclusion: Predictors of dural tears in posterior spinal fusion are hospital, independent of number of spinal surgeries and academic status of hospital, and number of segments of fusion. In fusions of four and more segments a threefold higher risk of dural tears in comparison to fusions of less than four segments should be taken into consideration

Background: A common complication of lumbar spine surgery is incidental tear of the dural sac and subsequent leakage of the cerebrospinal fluid intraoperatively. Studies have reported a wide variation in the rates of dural tears in spine surgery (1%–17%). The rates were higher after revision surgery. Objective: To establish a baseline rate of incidence of dural tears after lumbar surgery in Morriston Hospital Neurosurgical Unit and to compare it with the results reported in the literature. Methods and Results: A prospective review of the operation notes of 65 consecutive patients who had undergone lumbar surgery (Primary lumbar discectomy, primary lumbar laminectomy and revision lumbar discectomy) over a period of 3 months from Jan 2008. Patients were operated on by different neurosurgical consultants. 40 patients had primary lumbar discectomy of which 2 (5%) had dural tears. 20 patients had primary lumbar laminectomy of which 1 (5%) had a dural tear and 5 patients had revision lumbar discectomy of which 1 (20%) had a dural tear. All dural tears were repaired intraoperatively. Conclusion: This study shows that the highest percentage of incidental durotomy was in revision lumbar surgery which was also slightly higher than the reported rates (8.1%–17.4%). The percentage of dural tears after primary discectomy and primary laminectomy was within range of the percentages reported in the literature (1%–7.1%) and (3.1%–13%) respectively. A multicentre prospective larger study which includes all different surgical procedures performed on the lumbar spine is needed to establish a more accurate incidence rate for this common complication

Introduction and Aims: Incidental dural tears and cerebrospinal fluid (CSF) leaks are common complications of spinal surgery. Collagen matrix (DuraGen, Integra LifeSciences) derived from bovine flexor tendons allows CSF absorption up to 100 times its weight without a volume change. Aim of this study was categorising the dural tears and monitoring post-operative complications. Method: In this three-year prospective study, 35 patients (22 males, 13 females; mean age 53.8 years (range 16–82)) were selected by the following criteria: (1) any spine operation resulting in intra-operative CSF leak due to dural tear; or (2) persistent post-operative CSF leak. Collagen matrix was cut according to the extent of the dural defect (pinhole, < 1cm, 1–2 cm, and > 2cm). Dural matrix was moistened and applied as a graft and overlying tissues were meticulously reconstituted. Collagen sponge was not sutured on the dura. Subfascial drain was used at the discretion of surgeon to avoid hematoma and blood loss. Results: The 39 procedures were as follows: 23 laminectomies, six diskectomies, four hematoma repairs, three structural repairs, two fracture stabilisations and one cystectomy. The locations of the 39 procedures were: 27 lumbar, seven thoracic, and five cervical. In 33 of 39 procedures, hemovac subfascial drain was used to avoid hematoma and excessive blood loss. Fibrin glue was used in two cases only. In 13 cases the dural defect was > 2cm, five cases 1–2cm, five cases < 2cm, and nine were pinhole defects. Of importance was the successful repair of 13 large dural tears (> 2cm) using the collagen sponge. Our study showed a 97.4% success rate for repairing dural tears using the collagen sponge surpassing the established techniques success rates by up to 10%. There were no wound infections post-operatively, versus the 6% rate of deep wound infection using the standard suture and fibrin glue. The mean follow-up time was 3.1 months. In two out of 39 procedures collagen sponge was used to repair persistent post-operative CSF leaks (no dural sponge used in the original operation). Conclusion: Considering the technical challenge of dural tears, especially ventral or lateral tears, the use of collagen sponge offers an excellent alternative mini-mising a prolonged procedure, wound infection, use of tissue grafts, as well as excessive blood loss. This study showed collagen sponge to be effective as a permanent dural substitute

We reported the first single surgeon series comparing outcome of microscopic and open primary single level unilateral lumbar decompression or discectomy. We aimed to determine any difference in outcomes between the two techniques. Forty-six decompressions were performed with use of an operating microscope (microscopic), and forty without (open) at two different hospitals. All procedures were performed by the senior author. Information was obtained by analysis of the patients' notes. The average age of the patients in both groups was comparable. Operating time was shorter in the microscopic group (68min, range 30-130) compared to the open group (83 mins, range 30-180). Dural tear rate was 4.3% with use of a microscope (0% symptomatic dural tear rate) and 7.5% without (2.5% symptomatic dural tear rate). Nerve damage incidence was 0% with use of a microscope and 5% (two patients) without. One of these was a neurapraxia and the patient made a full recovery. Wound infection rates, diagnosed on grounds of clinical suspicion, were 4.3% and 2.5% for microscopic and open respectively. There were no incidences of deep infection or post-operative discitis. Average inpatient stay was under 48 hours in both groups. Using the modified Macnab criteria, results using the microscope were 0% poor, 14% fair, 32% good, and 55% excellent. The results for the open group were 0% poor, 10% fair, 37% good and 53% excellent. Average follow-up was six months (1-19) for the microscope group, and seven months (2-16) for the open group. We conclude that primary single level unilateral lumbar decompressive surgery, performed without the use of a microscope, has a higher dural tear rate than the same surgery performed with the benefit of an operating microscope. Surgical time and incidence of nerve damage are also reduced by use of the microscope

The August 2014 Spine Roundup. 360 . looks at: rhBMP complicates cervical spine surgery; posterior longitudinal ligament revisited; thoracolumbar posterior instrumentation without fusion in burst fractures; risk modelling for VTE events in spinal surgery; the consequences of dural tears in microdiscectomy; trends in revision spinal surgery; radiofrequency denervation likely effective in facet joint pain and hooks optimally biomechanically transition posterior instrumentation

The June 2014 Spine Roundup. 360 . looks at: spinal pedicle screws in paediatric patients; improving diagnosis in lumbar spine stenosis; back pain all in the head?; brace three patients, save one scoliosis operation; pedicle screws more often misplaced than one would think; and incidental dural tears usually no problem

The primary objective is to compare revision rates for lumbar disc replacement (LDR) and fusion at the same or adjacent levels in Ontario, Canada. The secondary objectives include acute complications during hospitalization and in 30 days, and length of hospital stay. A population-based cohort study was conducted using health administrative databases including patients undergoing LDR or single level fusion between October 2005 to March 2018. Patients receiving LDR or fusion were identified using physician claims recorded in the Ontario Health Insurance Program database. Additional details of surgical procedure were obtained from the Canadian Institute for Health Information hospital discharge abstract. Primary outcome measured was presence of revision surgery in the lumbar spine defined as operation greater than 30 days from index procedure. Secondary outcomes were immediate/ acute complications within the first 30 days of index operation. A total of 42,024 patients were included. Mean follow up in the LDR and fusion groups were 2943 and 2301 days, respectively. The rates of revision surgery at the same or adjacent levels were 4.7% in the LDR group and 11.1% in the fusion group (P=.003). Multivariate analysis identified risk factors for revision surgery as being female, hypertension, and lower surgeon volume. More patients in the fusion group had dural tears (p<.001), while the LDR group had more “other” complications (p=.037). The LDR group had a longer mean hospital stay (p=.018). In this study population, the LDR group had lower rates of revision compared to the fusion group. Caution is needed in concluding its significance due to lack of clinical variables and possible differences in indications between LDR and posterior decompression and fusion

Abstract. Background. Elderly patients with degenerative lumbar disease are increasingly undergoing posterior lumbar decompression without instrumented stabilisation. There is a paucity of studies examining clinical outcomes, morbidity & mortality associated with this procedure in this population. Methods. A retrospective analysis of aged 80–100 years who underwent posterior lumbar decompression without instrumented stabilisation at University Hospitals of Derby &Burton between 2016–2020. Results. Total 167 eligible patients, 163 octogenarians & 4 nonagenarians. Mean age was 82.78 ± 3.07 years. Mean length of hospital stay 4.79 ± 10.92 days. 76% were pain free at 3months following decompression. The average Charleston co-morbidity index (CCI) was 4.87. No association found with CCI in predicting mortality (ODD ratio 0.916, CI95%). 17patients suffered complications; dural tear (0.017%), post-op paralysis (0.017%), SSI(0.01%), and 0.001% of hospital acquired pneumonia, delirium, TIA, urinary retention, ileus, anaemia. High BMI (35+) was associated with increased incidence of complication (CI 95%, p<0.002). There was significant social drift following discharge as 147 patients went home and 4 patients to rehabilitation facility (p<0.001FE test). The mean operative time was 91.408±41.17 mins and mean anaesthetic time was 36.8±16.06 mins. Prolonged operative time was not associated with increased mortality.2year revision decompression rate was 0.011%. Conclusion. Posterior lumbar decompression without instrumented stablisation in elderly is safe & associated with low mortality with 99.5%survival at 1 year. It significantly improves PROMs & has extremely low revision rate. Incidence of post-op complication is <0.05% and 54% of patients get discharged within 72hours of surgery. Careful selection & optimising patients with high BMI would reduced perioperative morbidity and mortality

To establish whether incidental durotomy complicating lumbar spine surgery adversely affects long-term outcome. Data was collected prospectively. The study population comprised 200 patients. 19 patients who sustained dural tears (Group A) were compared to a control group of 181 patients with no tear (Group B). Outcomes were measured with the SF-36, Oswestry Disability Index (ODI) and visual analogue scores for back (VB) and leg (VL) pain. Scores for the 2 groups were compared pre-operatively, at 2 and 6 months post-op for all patients and at long-term follow-up (range 2-9 years) for patients in group A. In addition for patients in group A the patients satisfaction with the procedure, ongoing symptoms, employment status and analgesic intake were documented. Pre-operative scores were similar between the 2 groups apart from significantly higher vb scores (63 –A vs 46-B). Results at 2 and 6 months showed no significant differences between the 2 groups. Outcome scores for group A at long-term follow-up do not show any significant decline. Our study demonstrates that incidental dural tears complicating lumbar spine surgery do not adversely affect outcome in the long-term

Purpose. To establish whether incidental durotomy complicating lumbar spine surgery adversely affects long-term outcome. Methods. Data was collected prospectively. The study population comprised 200 patients. 19 patients who sustained dural tears (Group A) were compared to a control group of 181 patients with no tear (Group B). Outcomes were measured with the SF-36, Oswestry Disability Index (ODI) and visual analogue scores for back (VB) and leg (VL) pain. Scores for the 2 groups were compared pre-operatively, at 2 and 6 months post-op for all patients and at long-term follow-up (range 2-9 years) for patients in group A. In addition for patients in group A the patients satisfaction with the procedure, ongoing symptoms, employment status and analgesic intake were documented. Results. Pre-operative scores were similar between the 2 groups apart from significantly higher vb scores (63 –A vs 46-B). Results at 2 and 6 months showed no significant differences between the 2 groups. Outcome scores for group A at long-term follow-up do not show any significant decline. Conclusion. Our study demonstrates that incidental dural tears complicating lumbar spine surgery do not adversely affect outcome in the long-term. Ethics - none, Interest –none

Introduction and Objective. Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) represent the most popular techniques in performing an interbody fusion amongst spine surgeons. Pseudarthrosis, cage migration, subsidence or infection can occur, with subsequent failed surgery, persistent pain and patient’ bad quality of life. The goal of revision fusion surgery is to correct any previous technical errors avoiding surgical complications. The most safe and effective way is to choose a naive approach to the disc. Therefore, the anterior approach represents a suitable technique as a salvage operation. The aim of this study is to underline the technical advantages of the anterior retroperitoneal approach as a salvage procedure in failed PLIF/TLIF analyzing a series of 32 consecutive patients. Materials and Methods. We performed a retrospective analysis of patients’ data in patients who underwent ALIF as a salvage procedure after failed PLIF/TLIF between April 2014 to December 2019. We recorded all peri-operative data. In all patients the index level was exposed with a minimally invasive anterior retroperitoneal approach. Results. Thirty-two patients (average age: 46.4 years, median age 46.5, ranging from 21 to 74 years hold- 16 male and 16 female) underwent salvage ALIF procedure after failed PLIF/TLIF were included in the study. A minimally invasive anterior retroperitoneal approach to the lumbar spine was performed in all patients. In 6 cases (18.7%) (2 infection and 4 pseudarthrosis after stand-alone IF) only anterior revision surgery was performed. A posterior approach was necessary in 26 cases (81.3%). In most of cases (26/32, 81%) the posterior instrumentation was overpowered by the anterior cage without a previous revision. Three (9%) intraoperative minor complications after anterior approach were recorded: 1 dural tear, 1 ALIF cage subsidence and 1 small peritoneal tear. None vascular injuries occurred. Most of patients (90.6%) experienced an improvement of their clinical condition and at the last follow-up no mechanical complication occurred. Conclusions. According to our results, we can suggest that a favourable clinical outcome can firstly depend from technical reasons an then from radiological results. The removal of the mobilized cage, the accurate endplate and disc space preparation and the cage implant eliminate the primary source of pain reducing significantly the axial pain, helping to realise an optimal bony surface for fusion and enhancing primary stability. The powerful disc distraction given by the anterior approach allows inserting large and lordotic cages improving the optimal segmental lordosis restoration

Fractures and fracture dislocations involving the lower lumbar spine and lumbosacral junction are uncommon. These high velocity injuries are often associated with neurological deficit, incontinence and dural tears. The accepted treatment has been posterior stabilisation with fusion, but loss of reduction has often been reported. We reviewed our experience over the past four years in the management of eight male patients, two of whom sustained injuries in motor vehicle accidents and two in falls from a height. Two patients had L5/S1 traumatic spondylo-listhesis with no neurological deficit. Of the six patients with fracture dislocations of L3/4, four had translation in the sagittal and coronal planes and incomplete neurological deficit. Associated injuries in four patients included an ankle fracture, multiple rib fractures, dislocation of knee and hip, and a fracture dislocation of the midfoot. Following satisfactory reduction, seven patients were treated by posterior spinal fusion (PSF) with instrumentation. One patient had anterior decompression, strut-grafting and posterior instrumentation. Three patients had dural tears. In three patients treated by single segment PSF, reduction was not maintained. The maintenance of alignment was attributed to stable facet joints in one patient, two-segment instrumentation in three, and anterior strut grafting in one. One patient developed postoperative wound sepsis, which settled after repeated debridement and antibiotic treatment. Symptoms of nerve root compression improved in two of the four patients with neurological deficit. Posterior reduction and instrumentation alone did not maintain reduction in these severe injuries. Anterior column support and multisegmental instrumentation may be required where there is marked vertebral body compression and neurological deficit

Sublaminar wiring with posterior instrumentation is one of the methods used when long fusions involving 10 to 12 thoracolumbar levels are required. Classically wires are used at every consecutive level to make the construct as rigid as possible although complications like dural tears, CSF leak, and neurological deficiet have been reported during their passage. We compared the mechanical stability of five specimens of each of the three construct designs by static and fatigue testing to torsional strain on Electro-servo-hydraulic testing machine. In construct A, a contoured Hartshill rectangle was used from T2 to L2, with sub-laminar wires passed at every level. In construct B, every alternate level was wired. In construct C, every alternate level was wired except at the proximal end two consecutive levels were wired. Industrially fabricated spine models were used to prepare these constructs. The intervertebral motion within the construct was measured using FASTRAK magnetic field sensor device. On static testing, no statistically significant difference was found in the rotational displacement of the three construct designs. On fatigue testing, all samples of construct B consistently failed with breakage of the wire at the most proximal level on the left side. But on adding additional wires to the next level (Construct C), all five samples withstood fatigue testing at 300 Newton load to 3 million cycles. Wiring alternate levels instead of every level, does not compromise the stability of the construct provided the most proximal two levels are consecutively wired. This practise would minimise the risk of dural tears and cord damage during wire passage and reduce surgical time, not to mention the economical benefit

Aim: The aim is to correlate intra-operative findings such as epidural fibrosis (EF), size and type of disc fragment, lateral recess stenosis and dural tear with postoperative residual radiculopathy (RR) and residual low back pain (RLBP). Material and Methods: 246 revision discectomies performed between January 1994 and June 2004 were considered, of which adequate records were available for 215 (201 ipsilateral and 14 contralateral). Of 201 LIRDs, 85 were at L5S1, 101 at L45, 10 at L5S1+L45, 3 at L34 and 2 at L23 level. Patients who had had fusion or instrumentation in addition to LIRD were excluded. For 201 LIRDs average follow-up was 18.5 months (range −1 to 96 months) and 100 LIRDs had a minimum of 12 months’ follow-up. Results: Of the 179 first-time LIRDs, 65 (36.3%) had significant RR, 73 (40.8%) significant RLBP, 3 (1.7%) cauda equina syndrome, 2 (1.1%) infective discitis, and 1 (0.6%) foot-drop. Of the 21 second-time LIRDs, 15 (71.4%) had significant RR, 17 (81%) significant RLBP, 2 (9.5%) infective discitis and 1 (4.8%) cauda equina syndrome. EF was classified as abundant, moderate and scant. Incidence of RR and RLBP was proportional to amount of EF and size of hypertrophic scarred ‘disc’ bulge, but it correlated poorly with size of ‘soft’ disc prolapse. Lateral recess decompression in addition to LIRD did not significantly alter the incidence of RR and RLBP. 25 (12.4%) patients who had dural tear had worse results. Conclusions: Large proportion of LIRDs result in significant residual symptoms. Second-time LIRDs have higher complication rates and even poorer outcomes

Background. Previous surgery is known to increase the risk of complications during spine surgery, but few studies have quantified the dose-response effect using multivariate models to account for confounders. We quantified the effect of the number of prior spine surgeries on perioperative complications in patients undergoing surgery for lumbar degenerative disorders. Methods. We included data from 4′940 patients documented in Eurospine's Spine Tango Registry from 2004 to 2015. Medical history and surgical details were documented on the Tango Surgery form, as were surgical and general medical complications arising between admission and discharge. Multiple logistic regression models were built to investigate the relationship between the number of any previous surgeries and the presence of a perioperative complication, controlling for other potential confounders (age, sex, smoking, BMI, comorbidity, number of vertebral levels affected). Results. There were 9.4% surgical complications (most commonly dural tear, neurological sequelae, haematoma, infection) and 6.5 % general complications (most commonly cardiovascular, urinary, pulmonary, liver/GI). In the multivariable models, previous surgery significantly increased the odds of having a surgical complication (OR 1.148, 95%CI 1.051–1.253; p=0.002) and a medical complication (OR 1.185, 95%CI 1.074–1.307; p=0.001) i.e., for each previous surgery, the odds of a complication increased by 15% and 19%, respectively. Conclusion. We demonstrated a significant dose-response effect of previous surgery on the risk of incurring a complication during subsequent spine surgery. The results can be used by the surgeon when assessing the risk/benefit ratio of further surgery, for informing and consenting the patient. No conflicts of interest. No funding obtained

Introduction. Decompression is the gold standard surgical technique in patients with symptomatic spinal stenosis not responding to conservative management. We present an audit of outcomes in a population of patients undergoing this procedure over a four year period. Method. All patients undergoing lumbar decompression were assessed preoperatively and between 4 and 12 months postoperatively using the Oswestry Disabilty Index (ODI %), pain scale (0–10) and patient satisfaction. The patient's age, the number of levels decompressed and the incidence of complications were recorded. Results. Data is expressed as mean ±SD. Of 127 patients 112 were available for follow up. Mean age at surgery was 68.8±11.8 years. 55% of patients had a single level decompression, 36% 2 levels, 9% 3 levels. L4/5 was the most frequently decompressed level (51%) Improvement in ODI was 13.9±11.7(p<0.0001), improvement in pain scores 2.9±3.0 (p<0.0001). Improvement was the same regardless of number of levels decompressed (ANOVA p=0.84). There was no association between outcome and age. Dural tears occurred in 8.9% of patients, with post operative infection in 2.7%. The presence or absence of post operative complications did not significantly affect outcome. Based on outcome 87% of patients were happy with their surgical experience and outcome. Conclusion. Lumbar decompression remains an effective treatment for stenosis by improving ODI and pain scores. Age and number of decompression levels do not influence outcome. There is a high level of patient satisfaction with the procedure

The documentation of the results of combined anterior -posterior approach in the treatment of spinal tumors in our department. A total of 28 patients (16 men – 12 women) aged 15 to 75 year old (mean age = 54 years) were treated. Of those 7 presented with a benign primary tumor and 21 with malignancies of which 15 were metastatic. 16 patients had a neurologic deficit but met the international criteria for surgical intervention. The staging of the tumors and their postoperative care was undertaken by a tumor centre. All patients underwent posterior decompression with laminectomy, resection of all posterior elements including part of the pedicle, excision of the tumor and posterior stabilization. This was followed at the same operative session by an anterior approach (transthoracic, transperitoneal or anterior cervical) corpectomy of the affected vertebrae and implantation of interbody cages secured with an anterior plate and screws in the healthy vertebrae. 7 patients improved neurologically following the operation while 9 had no change of their clinical condition. Perioperative complications were recorded in 5 patients. In 3 cases a dural tear was dealt with direct closure and 3 infections had to have surgical debridement at another stage and antimicrobial therapy. The treatment of spinal tumors with combined anterior-posterior approach in one session for a radical excision of the tumor is a demanding procedure

To assess whether Patients who are clinically Obese are more likely to require further or revision Surgery following One-Level simple Microdiscectomy compared to Non-obese Patients. Retrospective, single centre and single Surgeon review of Patients' Clinical notes of consecutive Patients who underwent primary One-Level Microdiscectomy between December 2007 and July 2009. Background: Obesity in Surgery has become a topical subject given the increasing proportion of Surgical Patients being Obese. This study provides the largest single centre and single Surgeon comparative cohort. All Patients had undergone One-level simple Primary Microdiscectomy Surgery. Data from the Clinical notes included Patient Demographics, level and side of operation, Length of stay and Re-Operation details. A total number of 71 Patients were eligible for inclusion of which 38 were Female and 33 Male with an average age of 41 years. 25 Patients were Clinically Obese (35%). Average LOS was 1.1 days. 8% of the clinically Obese Patients required further Surgery compared to 8.7% in the Non-obese group. Revision surgery for recurrent discs and Surgery for dural tear repair were the main reasons for return to theatre. Revision rates were comparable between the two Patient groups. LOS was no different for Obese Patients. This study concludes that Obese Patients undergoing One-Level simple Microdiscectomy do not face a significantly higher risk of requiring Revision Surgery in the future