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Hu HT, Liu FY, Yu JH, Ren L, Gu ZF, Sun XZ. Vertebral column decortication for the management of sharp angular spinal deformity in Pott disease: Case report. Medicine (Baltimore) 2017; 96:e8592. [PMID: 29137084 PMCID: PMC5690777 DOI: 10.1097/md.0000000000008592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Extremely sharp angular spinal deformity of healed tuberculosis can be corrected by vertebral column resection (VCR). However, the VCR techniques have many limitations including spinal column instability, greater blood loss, and greater risk of neurologic deficit. PATIENT CONCERNS We described a new spinal osteotomy technique to collect sharp angular spinal deformity in Pott disease. A 52-year-old woman presented with back pain and gait imbalance. DIAGNOSIS The kyphosis of healed tuberculosis was diagnosed based on history and imaging examinations. INTERVENTION A new posterior VCR was designed to treat this disease. OUTCOMES The neurological function improved from Japanese Orthopedic Association scale 3 to 7. The back pain and neurological function were significantly improved. The Oswestry Disability Index decreased from 92 to 34. There was also a significant decrease in back pain visual analog scale from 9 to 2. LESSONS For cases with extremely severe Pott kyphotic deformity, the technology of modified VCR offers excellent clinical and radiographic results.
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Abstract
The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) has been shown to be useful in predicting postoperative complications. In this study, we aimed to evaluate the predictive value of the ACS-NSQIP calculator in geriatric patients undergoing lumbar surgery.A total of 242 geriatric patients who underwent lumbar surgery between January 2014 and December 2016 were included. Preoperative clinical information was retrospectively reviewed and entered into the ACS-NSQIP calculator. The predictive value of the ACS-NSQIP model was assessed using the Hosmer-Lemeshow test, Brier score (B), and receiver operating characteristics (ROC, also referred C-statistic) curve analysis. Additional risk factors were calculated as surgeon-adjusted risk including previous cardiac event and cerebrovascular disease.Preoperative risk factors including age (P = .004), functional independence (P = 0), American Society of Anesthesiologists class (ASA class, P = 0), dyspnea (P = 0), dialysis (P = .049), previous cardiac event (P = .001), and history of cerebrovascular disease (P = 0) were significantly associated with a greater incidence of postoperative complications. Observed and predicted incidence of postoperative complications was 43.8% and 13.7% (±5.9%) (P < .01), respectively. The Hosmer-Lemeshow test demonstrated adequate predictive accuracy of the ACS-NSQIP model for all complications. However, Brier score showed that the ACS-NSQIP model could not accurately predict risk of all (B = 0.321) or serious (B = 0.241) complications, although it accurately predicted the risk of death (B = 0.0072); this was supported by ROC curve analysis. The ROC curve also showed that the model had high sensitivity and specificity for predicting renal failure and readmission.The ACS-NSQIP surgical risk calculator is not an accurate tool for the prediction of postoperative complications in geriatric Chinese patients undergoing lumbar surgery.
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Affiliation(s)
| | - Yanting Hu
- Anesthesiology, Capital Medical University, Beijing, China
| | | | - Yue Su
- Beijing Shijitan Hospital
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Cheng X, Zhang K, Sun X, Zhao C, Li H, Ni B, Zhao J. Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis. Spine J 2017; 17:1127-1133. [PMID: 28416439 DOI: 10.1016/j.spinee.2017.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/11/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures. PURPOSE This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis. STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF. OUTCOME MEASURES Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score. METHODS The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168). RESULTS There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group. CONCLUSIONS When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery.
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Affiliation(s)
- Xiaofei Cheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Xiaojiang Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Changqing Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Hua Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China
| | - Bin Ni
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China..
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154
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Crawford AH, Hedley JE, Lam R, Drożdżyńska MJ, De Decker S. Surgical treatment of a paraspinal abscess with osteomyelitis and spinal cord compression in a rabbit. J Am Vet Med Assoc 2017; 251:340-344. [PMID: 28703667 DOI: 10.2460/javma.251.3.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 16-month-old neutered male Continental Giant rabbit (Lepus curpaeums) was referred for evaluation of a 7-day history of acute-onset, progressive, symmetric paraparesis. CLINICAL FINDINGS On initial examination, the rabbit was nonambulatory, and results of neurologic examination were consistent with a lesion affecting the T3-L3 spinal cord segments. Thoracic radiography showed irregular widening of the left T11-12 articular process joint. Marked dorsolateral and lateral extradural spinal cord compression with contrast enhancement of the adjacent epaxial muscles was evident on MRI images of the spine. TREATMENT AND OUTCOME A left-sided T11-T12 hemilaminectomy was performed, which revealed an abnormal and hypertrophic T11-12 articular process joint and an osteolytic lesion communicating with the vertebral canal. Copious purulent material causing marked spinal cord compression was evident, and the surgical site was lavaged extensively with sterile (0.9% NaCl) saline solution. Results of aerobic, anaerobic, and enriched bacteriologic cultures of swab specimens obtained from the surgical site were negative. Histologic analysis of biopsy samples revealed chronic purulent osteomyelitis, myositis, and fasciitis with necrosis, fibrosis, and dystrophic mineralization. The rabbit was discharged 48 hours after surgery. Ten weeks after surgery, the rabbit was ambulatory with mild paraparesis. On telephone follow-up 21 months after surgery, the owners indicated that the rabbit was healthy and expressed satisfaction with the treatment and outcome. CLINICAL RELEVANCE Paraspinal abscess with vertebral canal involvement should be considered as a differential diagnosis for rabbits with clinical signs of progressive T3-L3 myelopathy. Outcome for the patient of the present report suggested that surgical treatment including decompression and debridement can result in a favorable long-term outcome.
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155
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Salzmann SN, Lampe LP, Fernholz B, Härtl R, Patsalides A, Hughes AP. C2 Bone Erosion Secondary to Iatrogenic Pseudomeningocele: A Case Report and Description of a Novel Surgical Technique. World Neurosurg 2017; 106:1056.e1-1056.e4. [PMID: 28736355 DOI: 10.1016/j.wneu.2017.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pseudomeningoceles are a rare cause of bone erosions. Development of such erosions in the C2 vertebral body and the odontoid process can lead to life-threatening instability. Treatment options to regain stability include atlantoaxial and occipitocervical fusion. For patients with a history of Chiari decompression and large C2 lesions, common fusion techniques are not always feasible. In addition, fusion surgery sacrifices physiologic motion and is therefore a disabling procedure, especially for young and active patients. CASE DESCRIPTION We report a novel combined open operative and subsequent minimal invasive filling technique of several instable osteolytic/cystic areas within the C2 vertebra of a 28-year-old woman. The underlying cause for the lesions was a pseudomeningocele communicating with the vertebral body. This was an incidental finding 15 years after foramen magnum decompression with C1 and partial C2 laminectomy for Chiari malformation. Novel treatment included open posterior surgery with total laminectomy of the remaining C2 arch and refilling the odontoid with viscous beta tricalcium phosphate and polymethylmethacrylate bone cement. Postoperative 6- and 12-month follow-up computed tomography imaging showed a stable incorporation of the filling. CONCLUSIONS Life-threatening fractures at the occipitocervical junction are rare and often are due to high-impact trauma. Osteolytic changes at those bone compartments are a potential cause for pathologic fractures during normal daily activities. In this case, increased pressure on the bone due to a pseudomeningocele resulted in slow bone loss without symptoms. A novel combined technique of bone filling was applied successfully to stabilize the C2 vertebral bone.
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Affiliation(s)
- Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Lukas P Lampe
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Brian Fernholz
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Athos Patsalides
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA.
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156
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Vázquez EJ, Gefaell J, Fernandez L, López E, Areitio E, Elexpuru JA. Spinal extradural arteriovenous fistula with intradural drainage: three surgical cases with long-term follow-up. Acta Neurochir (Wien) 2017; 159:1107-1111. [PMID: 28378096 DOI: 10.1007/s00701-017-3150-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Abstract
Spinal extradural arteriovenous fistulas (SEDAVF) with intradural drainage are uncommon vascular lesions that cause venous congestive myelopathy. We present three SEDAVF with intradural drainage treated with surgical disconnection of the intradural drainage via a single level laminectomy, followed by transarterial embolization (TAE) with Onyx if spontaneous thrombosis of the extradural fistula did not occur spontaneously. All patients improved their neurological condition and no congestive myelopathy recurrence was noted after mean follow-up of 84 months. We believe that SEDAVF with intradural drainage constitute a specific entity that should be included in the classifications of spinal arteriovenous malformations.
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Affiliation(s)
- Enrique J Vázquez
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain.
- Department of Neurosurgery, Clínica IMQ Zorrotzaurre, Bilbao, Biscay, Spain.
| | - Joaquín Gefaell
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain
- Department of Neurosurgery, Clínica IMQ Zorrotzaurre, Bilbao, Biscay, Spain
| | - Leticia Fernandez
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain
| | - Eva López
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain
- Department of Neurosurgery, Clínica IMQ Zorrotzaurre, Bilbao, Biscay, Spain
| | - Eduardo Areitio
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain
- Department of Neurosurgery, Clínica IMQ Zorrotzaurre, Bilbao, Biscay, Spain
| | - Jose A Elexpuru
- Department of Neurosurgery, Hospital Universitario Basurto, Avenida de Montevideo 18, 48013, Bilbao, Biscay, Spain
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157
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Corrie C, Shmalberg J, Senneca C, Conner B. Use of a non-invasive surgical skin closure device in dogs following dorsolateral hemilaminectomy. Can Vet J 2017; 58:604-606. [PMID: 28588334 PMCID: PMC5432151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ZipLine 16 surgical skin closure device (ZipLine 16; Zipline Medical, Campbell, California, USA) provides noninvasive surgical wound closure. This prospective study investigated its use in dogs undergoing a dorsolateral hemilaminectomy. Although the device produced normal appositional healing compared with controls, unacceptable traumatic dermatitis that is likely related to the device adhesive was noted after removal.
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158
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Minamide A, Yoshida M, Iwahashi H, Simpson AK, Yamada H, Hashizume H, Nakagawa Y, Iwasaki H, Tsutsui S, Kagotani R, Sonekatsu M, Sasaki T, Shinto K, Deguchi T. Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes. J Orthop Sci 2017; 22:377-383. [PMID: 28161236 DOI: 10.1016/j.jos.2016.12.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/29/2016] [Accepted: 12/21/2016] [Indexed: 02/09/2023]
Abstract
There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe scoliosis, foramina stenosis, progressive scoliosis and large mismatch of PI-LL.
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Affiliation(s)
- Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Iwahashi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mayumi Sonekatsu
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takahide Sasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kazunori Shinto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Tsuyoshi Deguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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159
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Cheng X, Lou S, Huang S, Chen H, Liu J. Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution. World Neurosurg 2017; 106:113-119. [PMID: 28377242 DOI: 10.1016/j.wneu.2017.03.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed. METHODS Demographic, operative, and postoperative factors were recorded. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. RESULTS Eight males (57%) and 6 females (43%) were involved in the study. Their median age was 28 years (range, 14-56 years). Median Karnofsky Performance Status score was 60 (range, 20-90). Four patients (28.6%) received gross total resection, 5 (35.7%) partial resection, and the remaining 5 (35.7%) biopsy only. Nine patients (64.3%) received postoperative radiotherapy and chemotherapy, 3 (21.4%) chemotherapy only, and 2 (14.3%) neither. Median follow-up period was 15 months (range, 5-26 months). One-year and 2-year survival was 78.5% (11/14) and 7.1% (1/14), respectively. Median OS was 15 months, and median PFS 8 months. Univariate log-rank analysis showed that OS and PFS were significantly associated with patients' age (P = 0.007 and P = 0.04, respectively) and postoperative radiotherapy (P = 0.001 and P = 0.002, respectively). However, preoperative Karnofsky Performance Status score affected only OS and did not affect PFS (P = 0.033 and P = 0.106, respectively). CONCLUSIONS According to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.
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Affiliation(s)
- Xing Cheng
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Silong Lou
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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160
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Wang T, Tian XM, Liu SK, Wang H, Zhang YZ, Ding WY. Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade. Medicine (Baltimore) 2017; 96:e6421. [PMID: 28328846 PMCID: PMC5371483 DOI: 10.1097/md.0000000000006421] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan. METHODS An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3. RESULTS A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%-22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%-6.2%), 1.9% (95% CI 1.3%-2.4%), 2.8% (95% CI 1.7%-4.0%), 15.6% (95% CI 11.7%-19.5%), 16.8% (95% CI 13.6%-19.9%), 4.0% (95% CI 2.3%-5.7%), 2.6% (95% CI 0.2%-4.9%), 3.7% (95% CI 2.0%-5.5%), 3.4% (95% CI 2.0%-4.8%), 1.1% (95% CI 0.7%-1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%). CONCLUSIONS Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.
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Affiliation(s)
- Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Xiao-Ming Tian
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Si-Kai Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Ying-Ze Zhang
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Abstract
INTRODUCTION This is the first case report about a thoracic intraspinal schwannoma in twin pregnancy with aggressive clinical presentation. CLINICAL PRESENCE AND DIAGNOSES A 21-year-old woman presented with a 2-month history of back pain and slight lower extremity numbness and weakness, and her symptoms were misdiagnosed as normal reactions to pregnancy until she progressed to complete paralysis and incontinence within 2 weeks. She was then confirmed to have thoracic intraspinal schwannoma through MRI. INTERVENTIONS AND OUTCOMES Surgery was performed using a unilateral hemilaminectomy approach with a comfortable lateral position during operation. The patient exhibited significant improvements in sensation and muscle strength after surgery. She delivered 2 healthy baby girls by eutocia in her 38th week of pregnancy. LESSONS The diagnosis of this disease and the 4 possible mechanisms of its aggravated clinical presence are discussed. Intraspinal schwannomas during pregnancy are rare but may cause critical consequences for both the mother and the fetus. Timely diagnosis and multidisciplinary treatment by obstetricians, anesthesiologists, surgeons, oncologists, and neonatologists are essential for the clinical management of this disease.
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Affiliation(s)
- Ruiqi Chen
- Department of Neurosurgery, West China Hospital
| | - Anqi Xiao
- Department of Neurosurgery, West China Hospital
| | - Lu Xing
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital
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Yu CC, Gao WJ, Yang JS, Gu H, MD MZ, Sun K, Hao DJ. Can tranexamic acid reduce blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting: a retrospective observational study. Medicine (Baltimore) 2017; 96:e6043. [PMID: 28151914 PMCID: PMC5293477 DOI: 10.1097/md.0000000000006043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To assess the safety and efficacy of tranexamic acid (TXA) for decreasing perioperative blood loss in cervical laminectomy with lateral mass screw fixation and bone grafting (CLF), in which all surgical procedures are identical.From November 2014 to April 2016, we performed a retrospective comparative analysis of 119 patients with multilevel cervical spondylotic myelopathy who had undergone a CLF from C3 to C6 in our center. All surgeries were performed on the patients using a consistent, standard procedure. Patients were divided into control (46) and TXA (73) groups according to whether or not they had received TXA treatment before and during surgery. Demographic profiles of patients such as gender, age, body weight, height, and body mass index were collated and differences between the 2 groups compared. Preoperative and postoperative hematological data in addition to intraoperative and postoperative blood loss were compared between the 2 groups. Additionally, any complications of TXA were also evaluated to assess safety.There was no statistically significant difference in demographic traits between the 2 groups. Intraoperative blood loss in the TXA group (179.66 ± 81.45 mL) was significantly lower than that of the control group (269.13 ± 94.68 mL, P < 0.001), as was postoperative blood loss (108.08 ± 44.31 and 132.83 ± 49.39 mL, respectively; P = 0.005). Total blood loss in the TXA group (287.74 ± 115.40 mL) was also significantly lower than that of the control group (401.96 ± 127.88, P < 0.01). No major intraoperative complications occurred in any of the cases.TXA significantly reduced perioperative blood loss in CLF with no major side effects.
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Affiliation(s)
- Cheng-Cheng Yu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Wen-Jie Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Hua Gu
- Department of Neurosurgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang, China
| | - Ming Zhu MD
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Kai Sun
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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163
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Bhandutia AK, Zuzek Z, Schessler MJ, Tomycz ND, Altman DT. High Thoracic Disc Herniation Causing Horner Syndrome with the Intraoperative Finding of Conjoined Nerve Root Compression: A Case Report. JBJS Case Connect 2017; 7:e4. [PMID: 29244686 DOI: 10.2106/jbjs.cc.16.00106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 29-year-old man presented with right medial arm pain with paresthesia, as well as right-sided ptosis, miosis, and anhidrosis. Magnetic resonance imaging revealed a right paracentral disc herniation at the T1-T2 level. The patient underwent a hemilaminectomy with a medial facetectomy through a posterolateral approach to the T1-T2 disc space, followed by a discectomy. Intraoperative findings were notable for a conjoined nerve root. CONCLUSION Although high thoracic disc herniation is rare, its diagnosis should be considered when patients present with radicular arm pain and Horner syndrome. A high index of suspicion should be maintained for nerve root anomalies to limit iatrogenic injury and to ensure successful decompression.
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Affiliation(s)
- Amit K Bhandutia
- Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Zachary Zuzek
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Matthew J Schessler
- Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nestor D Tomycz
- Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Daniel T Altman
- Departments of Orthopaedic Surgery (A.K.B., M.J.S., and D.T.A.) and Neurosurgery (N.D.T.), Allegheny General Hospital, Pittsburgh, Pennsylvania
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164
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Yamaguchi K, Mathew J, Lhi JM, Park DY. Acute and Rapid Development of Spontaneous Spinal Epidural Hematoma Associated with Combined Aspirin-Dipyridamole Therapy: A Case Report. JBJS Case Connect 2017; 7:e19. [PMID: 29244699 DOI: 10.2106/jbjs.cc.16.00134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Spontaneous spinal epidural hematoma (SSEH) is a known, although rare, clinical entity that may be challenging to diagnose. This case report describes the rapid development of a large SSEH in an elderly patient on aspirin-dipyridamole combination therapy after she shifted her position in bed. Magnetic resonance imaging obtained 4 hours after the onset of symptoms demonstrated a large spinal epidural hematoma that extended from T4 to L1. CONCLUSION With early diagnosis, the patient was successfully treated with a laminectomy and evacuation of the hematoma, and there was full neurological recovery.
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Affiliation(s)
- Kent Yamaguchi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - Justin Mathew
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - James M Lhi
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Don Young Park
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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165
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Huang YP, Du CF, Cheng CK, Zhong ZC, Chen XW, Wu G, Li ZC, Ye JD, Lin JH, Wang LZ. Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis. PLoS One 2016; 11:e0166452. [PMID: 27870867 PMCID: PMC5117648 DOI: 10.1371/journal.pone.0166452] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/29/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries. Methods A finite element model of the L1–S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared. Results In Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs. Conclusions Preserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries.
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Affiliation(s)
- Yun-Peng Huang
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, 350005, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, Tianjin University of Technology, Tianjin, 300384, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Cheng-Kung Cheng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- Orthopaedic Device Research Center, National Yang-Ming University, 11221, Taipei, China
| | - Zheng-Cheng Zhong
- Orthopaedic Device Research Center, National Yang-Ming University, 11221, Taipei, China
| | - Xuan-Wei Chen
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, 350005, China
| | - Gui Wu
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, 350005, China
| | - Zhe-Cheng Li
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, 350005, China
| | - Jin-Duo Ye
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, Tianjin University of Technology, Tianjin, 300384, China
| | - Jian-Hua Lin
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, 350005, China
- * E-mail: (JHL); (LZW)
| | - Li Zhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Research Center for Implantable and Interventional Medical Devices, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- * E-mail: (JHL); (LZW)
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Shin SJ, Lee JH, So J, Min K. Anti-adhesive effect of poloxamer-based thermo-sensitive sol-gel in rabbit laminectomy model. J Mater Sci Mater Med 2016; 27:162. [PMID: 27646404 DOI: 10.1007/s10856-016-5773-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
Poloxamer-based thermo-sensitive sol-gel has been developed to reduce the incidence of postoperative scar formation at the laminectomy site. The purpose of this study was to evaluate the anti-adhesive effect of poloxamer based thermo-sensitive sol-gel compared to hyaluronate based solution after laminectomy, using a rabbit model. A thermo-sensitive anti-adhesive with a property of sol-gel transition was manufactured by a physical mixture of Poloxamer188/407, Chitosan and Gelatin. The viscosity in different temperatures was assessed. 72 adult New Zealand rabbits underwent lumbar laminectomy and were randomly divided into experimental (treated with the newly developed agent), positive (treated with hyaluronate based solution), and negative control groups. Each group was subdivided into 1 and 4-week subgroups. Gross and histological evaluations were performed to assess the extent of epidural adhesion. The experimental group showed significantly higher viscosity compared to the positive control group and showed a significant increase of viscosity as the temperature increased. Gross evaluation showed no statistically significant differences between the 1- and 4-week subgroups. However, histologic evaluation showed significant differences both in 1- and 4-week subgroups. Although the 4-week histologic results of the experimental and the positive control subgroups showed no significant difference, both subgroups revealed higher value compared to the negative control subgroup with regard to the ratio of adhesion less than 50 %. The new poloxamer based thermo-sensitive agent showed superior efficacy over the hyaluronate based agent at 1 week postoperatively. At 4 weeks postoperatively, there were no statistically significant differences between the two agents, although both showed efficacy over the sham group.
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Affiliation(s)
- Sung Joon Shin
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, 156-707, Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, 156-707, Korea.
- Institute of Medical and Biological Engineering, Seoul National University Medical Research Center, Seoul, 110-799, Korea.
| | - Jungwon So
- Research & Development Center, CGbio Co., Ltd. Seongnam-si, Gyeonggi-do, 462-120, Korea
| | - Kyungdan Min
- Research & Development Center, CGbio Co., Ltd. Seongnam-si, Gyeonggi-do, 462-120, Korea
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de Risi-Pugliese T, Danière F, Legrand L, Bancel P, Oppenheim C, Wipff J. Extramedullary hematopoiesis with spinal cord compression in pachydermoperiostosis. Joint Bone Spine 2016; 84:509-510. [PMID: 27777168 DOI: 10.1016/j.jbspin.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Tullia de Risi-Pugliese
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Rheumatology A Department, Cochin Hospital, APHP, 75014 Paris, France
| | - Florian Danière
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Neuroradiology Department, Sainte-Anne Hospital, 75014 Paris, France
| | - Laurence Legrand
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Neuroradiology Department, Sainte-Anne Hospital, 75014 Paris, France
| | - Philippe Bancel
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Orthopedic Department, Cochin Hospital, APHP, 75014 Paris, France
| | - Catherine Oppenheim
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Neuroradiology Department, Sainte-Anne Hospital, 75014 Paris, France; INSERM U894, 75014 Paris, France
| | - Julien Wipff
- Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Rheumatology A Department, Cochin Hospital, APHP, 75014 Paris, France.
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168
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Chotivichit A, Ruangchainikom M, Tongdee T, Wongkajornsilp A, Permpikul P, Korwutthikulrangsri E. A Prospective Randomized Controlled Trial Comparing Posterolateral Lumbar Fusion With and Without Bone Marrow Concentrate Augmentation in Single-Level Lumbar Spondylolisthesis. J Med Assoc Thai 2016; 99:1073-1079. [PMID: 29952189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bone marrow (BM), which is a good source of stem cells and biological factors, has the potential to enhance bone fusion. Simple centrifugation technique is one of the procedures used to concentrate BM aspirate for increasing number of cells. However, there are limited clinical study for using BM concentrate augmentation in spinal fusion. OBJECTIVE This study was designed to examine the spinal fusion enhancement effects of bone marrow (BM) concentrate augmentation on poster lateral lumbar fusion (PLF) with autologous local bone graft in terms of both quality and quantity, as compared with a control procedure without BM concentrate augmentation. MATERIAL AND METHOD Twelve patients with L4-L5 spondylolisthesis scheduled for PLF after decompressive laminectomy and pedicle screw instrumentation were included in this study. This prospective randomized controlled trial was conducted at Siriraj Hospital during the 2009 to 2012 study period. Patients were randomly assigned to two groups. One group underwent PLF with local bone graft with BM concentrate augmentation (BM group) and the other group underwent PLF with local bone graft only (non-BM group). Clinical outcomes were evaluated by the Oswestry Disability Index (ODI) preoperatively and at 3 and 6 months after PLF. Bone fusion quality was evaluated by bony bridging on 3D-CT imaging. Fusion mass volumes were measured on quantitative 3D-CT scans at 1 week and 6 months, postoperatively. RESULTS Clinical outcome scores did not differ between groups. Six-month postoperative 3D-CT imaging showed complete PLF bridging in 58.3% and 100% of patients in the BM and non-BM groups, respectively. PLF mass volumes were decreased at 6 months by 51.1% in the BM group and by 48.5% in the non-BM group. One patient in the BM group had local inflammation at the BM aspiration site. CONCLUSION Bone marrow concentrate augmentation in this small randomized controlled trial failed to demonstrate positive effects on autologous local bone graft in posterolateral lumbar fusion relative to both quality and quantity. The high percentage of incomplete bridging should also be noted and further investigated.
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Baghdadi YMK, Moussallem CD, Shuaib MA, Clarke MJ, Dekutoski MB, Nassr AN. Lumbar Spinous Process-Splitting Laminoplasty: A Novel Technique for Minimally Invasive Lumbar Decompression. Orthopedics 2016; 39:e950-6. [PMID: 27337665 DOI: 10.3928/01477447-20160616-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/09/2016] [Indexed: 02/03/2023]
Abstract
Minimally invasive posterior spinous process-splitting laminoplasty preserving the paraspinal musculature has been introduced to treat patients with lumbar spinal stenosis. Despite its theoretical advantage of limiting muscular trauma, additional efforts are required to evaluate patients' clinical and functional results following this procedure. Between 2010 and 2012, 37 patients underwent spinous process-splitting laminoplasty for lumbar stenosis at a mean age of 68 years (range, 36-87 years) and were followed for minimum of 1 year (mean, 1.3 years). There were 22 (59%) men and 15 (41%) women. Mean number of levels treated with a spinous process-splitting laminoplasty was 2.2 (range, 1-6 levels). Patients had statistically significant improvements in their scores for all self-reported outcomes, including visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Short Form 36 (SF-36) components. Mean VAS significantly decreased by 4.4±3.2 points for back pain and 3.9±3.7 points for leg pain (P<.0001). Mean ODI significantly decreased by 17.5±19.1 points (P<.0001), and mean SF-36 significantly increased by 29±30.4 points (P=.0017) for the physical component and 21.8±25.6 points (P=.0062) for the mental health component. Four (10.8%) patients had a dural tear requiring repair (3 were intraoperative), 3 (8%) had an epidural hematoma requiring evacuation, 1 (2.7%) had an infection requiring irrigation and debridement, and 2 (5%) had additional decompression for symptom recurrence secondary to instability. Lumbar spinous process-splitting laminoplasty is a novel minimally invasive technique that provides adequate decompression for the neuronal elements and may avoid extensive paraspinal muscular damage associated with conventional laminectomy. Patients demonstrated significant improvements in pain and overall heath and function scores at a minimum 1-year follow-up. [Orthopedics.2016; 39(5):e950-e956.].
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170
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Bu G, Shuang F, Liu G, Wu Y, Hou S, Ren D, Shang W. Efficacy and Safety of One-Stage Selective Discectomy Combined with Expansive Hemilaminectomy in the Treatment of Cervical Spondylotic Myelopathy. World Neurosurg 2016; 94:507-512. [PMID: 27338214 DOI: 10.1016/j.wneu.2016.06.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We designed a novel surgical strategy named one-stage selective discectomy combined with expansive hemilaminectomy, which might theoretically reduce the postoperative complications of cervical spondylotic myelopathy (CSM). The objective of this study is to evaluate its efficacy and safety. METHODS Sixty-two patients with CSM were enrolled in this study. The procedure includes selective discectomy with fusion at 1 or 2 segments of maximal cord compression and expansive hemilaminectomy on the symptomatic or severe side of the body. Neurologic function was evaluated using the Japanese Orthopedics Association Score before and after surgery. Midsagittal dural sac diameter, dural sac transverse area at segments of discetomy on magnetic resonance imaging, and lordosis of the cervical spine on lateral plain film were measured. All patients were followed up for more than 1 year. RESULTS A total of 88 discs and 272 hemilaminas were resected from 62 patients. The Japanese Orthopedics Association Score improved from 8.7 ± 1.76 preoperatively to 13.4 ± 1.61 at 1 year follow-up (P < 0.001). The mean midsagittal dural sac diameter, dural sac area, and lordotic angle also increased from 0.45 ± 0.10 cm, 0.83 ± 0.14 cm2, and 7.9 ± 2.60° to 0.81 ± 0.08 cm, 0.96 ± 0.14 cm2, and 11.7 ± 3.06°, respectively (P < 0.05). No case of postoperative axial pain, C5 palsy, nonunion, or kyphosis was reported. CONCLUSIONS One-stage selective discectomy combined with expansive hemilaminectomy is an effective surgical approach for the treatment of CSM in patients whose neurologic function, midsagittal dura sac diameter, and dura transverse area can be improved and has few postoperative complications.
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Affiliation(s)
- Guoyun Bu
- The 1(st) Department of Spine of Tianjin Hospital, Tianjin, China
| | - Feng Shuang
- Chinese People's Liberation Army No. 94 Hospital, Nanchang, China
| | - Gang Liu
- The 1(st) Department of Spine of Tianjin Hospital, Tianjin, China
| | - Ye Wu
- Department of Orthopaedics, the First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Shuxun Hou
- Department of Orthopaedics, the First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Dongfeng Ren
- Department of Orthopaedics, the First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weilin Shang
- Department of Orthopaedics, the First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, China
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Liu FY, Yang SD, Huo LS, Wang T, Yang DL, Ding WY. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: A meta-analysis. Medicine (Baltimore) 2016; 95:e03588. [PMID: 27281067 PMCID: PMC4907645 DOI: 10.1097/md.0000000000003588] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/20/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
Abstract
This is a meta-analysis to compare the results between laminoplasty and laminectomy followed by fusion for the patients with multilevel cervical compressive myelopathy. An extensive search of literature was performed in MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), cervical lordosis (C2-7), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. A total of 23 studies comprising 774 and 743 patients treated with laminoplasty and laminectomy followed by fusion, respectively, were included in the final analysis. The pooled analysis showed that there was no significant difference in preoperative JOA scores [P = 0.89], postoperative JOA scores [P = 0.13], JOA scores improvement rate [P = 0.27], preoperative CCI [P = 0.15], postoperative CCI [P = 0.14], preoperative VAS [P = 0.41], postoperative VAS [P = 0.52], preoperative cervical lordosis (C2-7) [P = 0.46], postoperative cervical lordosis (C2-7) [P = 0.67], total complications [P = 0.07], axial pain [P = 0.94], and blood loss [P = 0.51]. However, there were significant difference in operation time (WMD = -19.57 [-32.11, -7.02], P = 0.002) and C5 palsy (OR = 0.26 [0.15, 0.44], P < 0.001). As compared with laminectomy followed by fusion, expansive laminoplasty showed no significant differences in JOA scores, CCI, ROM, VAS, cervical lordosis (C2-7), axial pain, total complications, and blood loss, but shorter operation time and fewer C5 palsy.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Li-Shuang Huo
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics
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Saetia K, Kuonsongtham V. Central Spinal Canal Decompression for Lumbar Spondylosis with Uniportal Full-Endoscopic Interlaminar Approach: Technical Note and Preliminary Results in Thailand. J Med Assoc Thai 2016; 99 Suppl 3:S16-S22. [PMID: 29901333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe surgical techniques for central spinal canal decompression with uniportal full-endoscopic interlaminar approach and report preliminary results of the first three cases. MATERIAL AND METHOD Surgical technique for uniportal full-endoscopic interlaminar approach for central spinal canal decompression was described step by step. Three consecutive cases that were operated by this new technique were illustrated by retrospective chart review. Results: All three illustrative cases achieved excellent clinical outcomes in terms of leg pain and claudication without postoperative complications. A follow-up period was two to eight months. Intra-operative blood loss varied from 20 to 50 milliliter. All cases were discharged from the hospital within two days after surgery. CONCLUSION Uniportal full-endoscopic interlaminar approach is a viable alternative procedure for central spinal canal decompression with the advantages of smaller skin incision and less tissue trauma. However, studies with larger number of cases and longer follow-up periods are needed in order to make a clear conclusion of the superiority of this new technique comparing to conventional microsurgical laminectomy.
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173
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Peddada K, Elder BD, Ishida W, Lo SFL, Goodwin CR, Boah AO, Witham TF. Clinical outcomes following sublaminar decompression and instrumented fusion for lumbar degenerative spinal pathology. J Clin Neurosci 2016; 30:98-104. [PMID: 27056673 DOI: 10.1016/j.jocn.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 11/17/2022]
Abstract
Traditional treatment for lumbar stenosis with instability is laminectomy and posterolateral arthrodesis, with or without interbody fusion. However, laminectomies remove the posterior elements and decrease the available surface area for fusion. Therefore, a sublaminar decompression may be a preferred approach for adequate decompression while preserving bone surface area for fusion. A retrospective review of 71 patients who underwent sublaminar decompression in conjunction with instrumented fusion for degenerative spinal disorders at a single institution was performed. Data collected included demographics, preoperative symptoms, operative data, and radiographical measurements of the central canal, lateral recesses, and neural foramina, and fusion outcomes. Paired t-tests were used to test significance of the outcomes. Thirty-one males and 40 females with a median age 60years underwent sublaminar decompression and fusion. A median of two levels were fused. The mean Visual Analog Scale pain score improved from 6.7 preoperatively to 2.9 at last follow-up. The fusion rate was 88%, and the median time to fusion was 11months. Preoperative and postoperative mean thecal sac cross-sectional area, right lateral recess height, left lateral recess height, right foraminal diameter, and left foraminal diameter were 153 and 209mm(2) (p<0.001), 5.9 and 5.9mm (p=0.43), 5.8 and 6.3mm (p=0.027), 4.6 and 5.2mm (p=0.008), and 4.2 and 5.2mm (p<0.001), respectively. Sublaminar decompression provided adequate decompression, with significant increases in thecal sac cross-sectional area and bilateral foraminal diameter. It may be an effective alternative to laminectomy in treating central and foraminal stenosis in conjunction with instrumented fusion.
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Affiliation(s)
- Kranti Peddada
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Akwasi O Boah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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174
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Karasu H, Güzel I. COMPARISON TACHOCOMB WITH SURGIWRAP, SURGICEL AND LYODURA IN EPIDURAL FIBROSIS: AN EXPERIMENTAL RAT MODEL. Ideggyogy Sz 2016; 69:195-200. [PMID: 27468609 DOI: 10.18071/isz.69.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We designed this study to evaluate the effect of TachoComb and to compare it with SurgiWrap, Surgicel, and Lyodura in an experimental rat model for epidural fibrosis (EF). METHODS This prospective and experimental rat model study was performed at Dicle University, School of Medicine, Department of Neurosurgery, in Diyarbakir, Turkey, between January 2005 and June 2005, using 50 Sprague Dawley rats (30 female and 20 male) with a mean weight of 290 g. The rats were divided into five groups: TachoComb, Surgicel, SurgiWrap, Lyodura, and control. RESULTS Eight weeks after laminectomy, the rats were killed and EF was evaluated. EF was statistically different between the groups. The lowest EF score was in the TachoComb group (F = 6.915, p < 0.001). CONCLUSIONS According to this study, TachoComb was found to be a more effective agent in decreasing EF than Surgicel, SurgiWrap, or Lyodura.
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175
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Aizawa T, Ozawa H, Hashimoto K, Kanno H, Kokubun S, Itoi E. Benign thoracic dumbbell tumor can be removed through hemilaminectomy and facetectomy without spinal reconstruction. J Neurosurg Sci 2016; 60:145-148. [PMID: 26947788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Toshimi Aizawa
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan -
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176
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Ravindra VM, Mazur MD, Driscoll M, McEvoy S, Schmidt MH. BRCA2-positive spinal intramedullary ovarian metastatic disease: case report. Spine J 2016; 16:e201-7. [PMID: 26552643 DOI: 10.1016/j.spinee.2015.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/09/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ovarian cancer is the fourth leading cause of cancer death in women, but advances in treatment have led to longer survival among these patients. Tied to these advances and increased survival, however, have been new patterns of metastatic spread. PURPOSE The authors discuss the management and surgical decision making in patients with intramedullary ovarian metastatic disease using a case illustration and relevant literature. STUDY DESIGN/SETTING A case report was used. METHODS The authors describe a case of a 59-year-old woman with Breast Cancer gene (BRCA) 2-positive ovarian cancer who developed progressive myelopathy from a T10 to T11 intramedullary metastatic lesion. RESULTS The patient underwent a standard open T10-T11 laminectomy for intramedullary tumor resection. Intraoperative ultrasound was used to direct the dural opening over the lesion. After a posterior midline myelotomy, microsurgical dissection revealed the intramedullary tumor with a discolored fibrous capsule, which was carefully dissected off of the spinal tracts, and a gross total resection was achieved. Postoperative magnetic resonance imaging at 6 months demonstrated no evidence of residual or recurrent intramedullary tumor. The patient underwent adjuvant external beam radiation to the thoracic spine but succumbed to her primary disease 1 year after surgery. CONCLUSION Although central nervous system involvement of ovarian cancer confers a poor prognosis, patients presenting with a solitary lesion and neurologic deficit may benefit from surgical resection followed by steroids and radiation therapy, especially when tissue diagnosis is necessary.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meghan Driscoll
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sara McEvoy
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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177
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Hiebert EC, Gambino J, Kepler D, Beasley M. What Is Your Neurologic Diagnosis? Intervertebral Disk Disease. J Am Vet Med Assoc 2016; 248:59-62. [PMID: 26684091 DOI: 10.2460/javma.248.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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178
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Pourtaheri S, Billings C, Bogatch M, Issa K, Haraszti C, Mangel D, Lord E, Park H, Ajiboye R, Ashana A, Emami A. Outcomes of Instrumented and Noninstrumented Posterolateral Lumbar Fusion. Orthopedics 2015; 38:e1104-9. [PMID: 26652331 PMCID: PMC5561727 DOI: 10.3928/01477447-20151120-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 04/09/2015] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of posterolateral lumbar fusion for lumbar stenosis cases requiring bilateral facetectomy in conjunction with a laminectomy. The authors evaluated 34 consecutive patients who had undergone a lumbar laminectomy, bilateral partial facetectomy, and posterolateral fusion at a single institution between 1981 and 1996. They included 25 men and 9 women with a mean age of 42 years (range, 27-57 years). Twenty-three cases were instrumented and 11 were noninstrumented. Mean follow-up was 21 years (range, 15-29 years). Outcomes evaluated included reoperation rate, clinical outcomes evaluated by the Oswestry Disability Index (ODI) score, radiographic evaluations of adjacent segmental degeneration (ASD) and lumbar lordosis, and contributing demographic factors to disease progression. At final follow-up, 17 of the 34 patients had undergone reoperation (43% of the instrumented group and 64% of the noninstrumented group). There were no differences in the reoperation rate or ODI improvement between the instrumented and noninstrumented groups (P>.05). Female patients required more revisions, had less ODI improvement, had greater postoperative ASD, and had less maintenance of their postoperative lumbar lordosis. There was no difference in maintenance of postoperative lumbar lordosis or ASD between the instrumented and noninstrumented groups. Instrumentation did not improve revision rates, clinical outcomes, or radiographic outcomes in laminectomies requiring contemporaneous facetectomies.
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179
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Aoyama T, Miyaoka Y, Ogiwara T, Ito K, Seguchi T, Hongo K. Long Segment Spinal Dural Cyst: A Case Report. World Neurosurg 2015; 88:686.e13-686.e17. [PMID: 26585731 DOI: 10.1016/j.wneu.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal meningeal cysts are a rare benign disease that can cause myelopathy. In most cases, spinal meningeal cysts consist of an arachnoid membrane. To the best of our knowledge, few articles have report on intradural spinal meningeal cyst consisting of dura mater. CASE DESCRIPTION A 58-year-old man presented to our institute with aggravation of clumsy hands and dysesthesia of the feet. Magnetic resonance imaging of the entire spine revealed a cystic lesion compressing the spinal cord posteriorly. Cyst fenestration and placement of the cyst-subarachnoid shunt was performed via an anterior approach. Postoperatively, the histopathologic results revealed that the cyst wall consisted of a dura mater-like membrane. The patient's symptoms resolved without the appearance of any new neurologic deficits. CONCLUSIONS The etiology of spinal meningeal cysts remains unclear. Spinal meningeal cysts consisting of dura mater (spinal dural cysts) are extremely rare. Treatment with only decompression with laminectomy causes enlargement of the dural cyst later. Cyst fenestration and placement of a cyst-subarachnoid shunt for the spinal dural cyst resulted in the resolution of myelopathy and cyst shrinkage.
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Affiliation(s)
- Tatsuro Aoyama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Seguchi Neurosurgical Hospital, Iida, Japan.
| | - Yoshinari Miyaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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180
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Abstract
The objective of this study was to investigate short segment decompression of degenerative lumbar scoliosis (DLS) and the efficiency of fusion treatment.After DLS surgery, the patients were retrospectively reviewed using the VAS (visual analog scale) and ODI (Oswestry Disability Index) to assess clinical outcomes. All patients underwent posterior lumbar decompressive laminectomy, pedicle screw internal fixation, and posterolateral bone graft fusion surgery. Radiographic measurements included the scoliotic Cobb angle, the fused Cobb angle, the anterior intervertebral angle (AIA), the sagittal intervertebral angle (SIA), and lumbar lordosis angle. The relationships between these parameters were examined by bivariate Pearson analysis and linear regression analysis.Preoperatively, the Cobb angle at the scoliotic segment was 15.4°, which decreased to 10.2° immediately following surgery (P < 0.05). The AIA significantly increased by the last follow-up (4.4 ± 3.4) compared with pre- and postoperative values (2.5 ± 2.8 and 2.2 ± 2.4, respectively; P < 0.05). However, the scoliotic Cobb angle and the AIA did not correlate with the VAS or ODI scores. At the final follow-up, no patients had pseudoarthrosis or internal instrumentation-related complications.Short fusion surgical treatment results in limited DLS correction, with correction loss over time. The AIA between the upper adjacent segment and proximal fused vertebra continues to increase postoperatively, which does not exacerbate clinical symptoms, as reflected by the low reoperation rates for repairing degeneration at adjacent levels.
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Affiliation(s)
- Naiguo Wang
- From the Department of Spinal Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
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181
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Mielke D, Rohde V. Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir (Wien) 2015; 157:1813-7. [PMID: 26298593 DOI: 10.1007/s00701-015-2549-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/11/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In cervical spondylotic myelopathy (CSM), laminoplasty (LP) or laminectomy plus fusion (LF) are accepted operative options and alternatives to anterior approaches. Both LP and LF have distinctive disadvantages, which might be avoided by unilateral hemilaminectomy and bilateral decompression of the spinal cord. METHODS Description of the surgical technique, indications, and limitations. The potential advantages in comparison to LP and LF are discussed. CONCLUSIONS Unilateral hemilaminectomy allows bilateral decompression of the whole dorsal circumference of spinal cord from nerve root to nerve root. The potential major advantages are a reduction of invasiveness by only unilateral muscle detachment, avoidance of implants, and shorter operation times.
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Affiliation(s)
- Dorothee Mielke
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- Klinik und Poliklinik für Neurochirurgie, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
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182
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Takai K, Taniguchi M. Microsurgical resection of an intramedullary glomus arteriovenous malformation in the high cervical spinal cord: retrograde dissection techniques of the nidus located between spinal tracts. Acta Neurochir (Wien) 2015; 157:1659-64. [PMID: 26276470 DOI: 10.1007/s00701-015-2531-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spinal intramedullary arteriovenous malformations (AVMs) fed by an anterior spinal artery are surgically challenging vascular lesions. METHOD We herein presented microsurgical resection techniques for an intramedullary glomus AVM located in the lateral part of the high cervical spinal cord with an operative video. These techniques included (1) a lateral suboccipital approach via cervical hemilaminectomy in the lateral position; (2) retrograde dissection of the AVM located between the spinal tracts; (3) coagulation and division of multiple narrow sulcal branches of the anterior spinal artery. CONCLUSION Patients who underwent these techniques achieved good outcomes with minimal bleeding and morbidity.
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Affiliation(s)
- Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan
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183
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Abstract
The spatial relations between the aorta and vertebrae are changing with posture, surgical techniques, and operative maneuvers. "Risky screws" (within 1-3 mm proximity to the aorta or other adjacent tissues) were found in 5.8-15.2% screws. In order to avoid early and later aortic complications secondary to scoliotic operations, careful preoperative metrology of aorto-vertebrae relations is of crucial importance. Compared with patients with idiopathic scoliosis, Marfan-related scoliosis is characterized by faster progression and it is more bracing-resistant due to the particular developmental anomalies in Marfan syndrome, implying the refractory nature of the latter. The present study aims to highlight the clinical impact of preoperative aorto-vertebra metrology in the scoliotic operations.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, P. R. China
| | - Guo-Rong Wang
- Department of Orthopedics, The First Hospital of Putian, Teaching Hospital, Fujian Medical university, Putian, Fujian Province, P. R. China.
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184
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Geftler A, Sasson A, Shelef I, Perry ZH, Atar D. Cauda Equina Syndrome in a 36 Week Gravida Patient. Isr Med Assoc J 2015; 17:522-523. [PMID: 26394499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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185
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Dogan I, Kahilogullari G, Guner E, Unlu A. A rare and unexpected clinical progress and location on a primary extradural spinal hydatid cyst in a pediatric patient: a case report. Childs Nerv Syst 2015; 31:1407-11. [PMID: 25930726 DOI: 10.1007/s00381-015-2728-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/20/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Involvement of spine in patients with hydatid disease (HD) is less than 1% and primary intra-spinal extradural HD is extremely rare. Although this disease is introduced as benign pathology according to its clinical presentation and biological behavior, intraoperative rupture of the cyst may aggravate the patients' outcome in the long-term especially in pediatric patient population. CASE PRESENTATION We report a 9-year-old girl who presented a progressive neurological deterioration due to an enlargement of a ventrally located extradural hydatid cyst within the thoracic spinal canal. Total removal of the cyst was achieved by preserving the capsule integrity for preventing potential seeding. Our preoperative initial diagnosis based on the radiological findings was confirmed as cyst hydatid histopathologically. CONCLUSION Cyst hydatid should be considered in the differential diagnosis of the presence of homogenous cystic lesions with regular shape inside the spinal canal especially in patients from endemic region. To our knowledge, this pediatric patient is the first case of cyst hydatid located ventral side of the spinal cord extradurally located inside the spinal canal showing no extension.
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Affiliation(s)
- Ihsan Dogan
- Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, 06100, Ankara, Turkey
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186
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Jonnavithula N, Garre S, Pasupuleti S, Durga P, Kulkarni DK, Ramachandran G. WOUND INSTILLATION OF LOCAL ANESTHETIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA FOLLOWING LUMBAR LAMINECTOMY. Middle East J Anaesthesiol 2015; 23:193-198. [PMID: 26442396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Lumbar laminectomy is a commonly performed procedure in neurosurgical and orthopedic practice. Postoperative pain reliefhelps in early mobilization, initiation of physiotherapy, provides satisfaction to the patients and plays an important role in reducing the morbidity and mortality. This prospective study investigated the simple technique of instillation of wound with bupivacaine and leaving a contact time of 60 seconds on postoperative pain following lumbar laminectomy. METHODS 32 ASA I and II patients scheduled for laminectomy were randomly allocated to receive either 20 ml of normal saline (group I) or 0.25% of bupivacaine (group II) into the wound after securing hemostasis. After a dwell time of 60sec the wound was closed in layers without mopping or suctioning. After extubation, the pain scores were evaluated by visual analog scale at every 4 hrs. for 24hrs and also the time for first demand of analgesia, number of analgesic demands and the total amount of analgesia consumed were noted by an independent observer.. RESULTS The median duration of analgesia in group I was 8.8 [5-11] and in group II 13 [8.5-16] hrs. with a p = 0.04. The number of demands and the amount of analgesia consumed was also statistically significant. CONCLUSION Wound instillation technique is simple, safe and effective in management of acute pain management after lumbar laminectomy and can be used as one among the multimodal armamentarium in pain management.
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187
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Hwang R, Yung BH, Sedney C, Miele VJ. Treatment of holocord spinal epidural abscess via alternating side unilateral approach for bilateral laminectomy. W V Med J 2015; 111:14-18. [PMID: 26050292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To date, this is the first reported case of the surgical management of a holocord epidural abscess done through level-skipping laminectomies. It is also the first reported case of these laminectomies being performed via an alternating side unilateral approach for this condition. A 51-year-old patient presenting with progressive lower extremity weakness secondary to a spinal epidural abscess extending from C4 to S1. A minimally disruptive method of relieving the spinal cord compression via evacuation of the abscess was employed successfully. This report demonstrates the efficacy of level skipping laminectomies via a unilateral approach for holocord epidural abscesses (extending 20 vertebral levels). Performing the laminectomies via a unilateral approach as well as alternating the side of the approach minimized iatrogenic instability risk. Both strategies were designed to minimize incision size, tissue disruption, and the amount of muscular weakness/imbalance postoperatively.
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188
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Elgafy H, Olson D, Liu J, Lewis C, Semaan H. Effectiveness and safety of transforaminal lumbar interbody fusion in patients with previous laminectomy. Eur Spine J 2015; 24:810-6. [PMID: 25527402 DOI: 10.1007/s00586-014-3726-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) for revision lumbar spine surgery in patients with previous laminectomy. The secondary objective was to evaluate the clinical and radiological outcome after such a procedure. METHODS Retrospective case series study. Eighty-two patients were included. There were 48 women (58.5 %) and 34 men (41.5 %) with a mean age of 51 years (range 26-84) at the time of index procedure. The outpatient and inpatient charts were reviewed to identify patients' demographic data, preoperative, perioperative, and postoperative data. The outcome measures were assessed by Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. An independent spine surgeon and musculoskeletal radiologist reviewed the imaging studies. RESULTS The average operative time was 160 min (range 131-250). The average estimated blood loss was 652 cc (100-1,400 cc). Nineteen patients (23.1 %) required blood transfusion. Five patients (6 %) had dural tear. One patient (1.2 %) had a surgical site infection. Two patients (2.4 %) had thromboembolic events. The average hospital stay was 3.8 days (2-5 days). At a mean follow-up of 28 months, there were statically significant improvement in the ODI and VAS for back and leg pain. None of the patients' radiographs showed hardware failure or pedicle screw loosening and no patient returned to the operating room for pseudarthrosis. CONCLUSIONS The current study confirmed that TLIF approach in patients with previous laminectomy is effective and safe with good outcomes.
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Affiliation(s)
- Hossein Elgafy
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA,
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189
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Geng XP, Wang X, Meng T, Li JJ, Li XC, Fu GY. THE INFLUENCE OF POSTERIOR APPROACH CERVICAL INTRASPINAL TUMOR RESECTION ON THE STABILITY OF CERVICAL VERTEBRA. J BIOL REG HOMEOS AG 2015; 29:389-394. [PMID: 26122227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper discusses the influence of posterior approach cervical intraspinal tumor resection on the stability of cervical vertebra. A total of 32 patients with cervical intraspinal tumor were included and divided into a group undergoing posterior approach bilateral vertebral lamina resection (group A) (n=16) and a group undergoing posterior approach semi-laminectomy (group B) (n=16). It was found, through follow-up visits, that the incidence rate of cervical instability of the patients was 25% and the incidence rate of cervical curvature deterioration of the patients was 37.5% in group A, whereas the two incidence rates of group B were 6.25% and 12.5% respectively; the incidence rates of cervical curvature deterioration and instability were significantly increased compared to group B (P< 0.05). It is concluded that, both regular posterior approach vertebral lamina resection and semi-laminectomy influence the biomechanical change of cervical vertebra, but the influence of the latter is less. Also, it is found that, applying titanium connectors and titanium nails for rigid internal fixation maintains the completeness and stability of the structure of the cervical vertebra.
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Affiliation(s)
- X P Geng
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - X Wang
- Department of Orthopedics, Binzhou Peoples Hospital, Binzhou, China
| | - T Meng
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - J J Li
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - X C Li
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - G Y Fu
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, China
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190
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Strong MJ, Thompson EM, Roundy N, Selden NR. Use of lumbar laminoplasty vs. laminotomy for transection of the filum terminale does not affect early complication rates or postoperative course. Childs Nerv Syst 2015; 31:597-601. [PMID: 25578961 PMCID: PMC8520122 DOI: 10.1007/s00381-015-2615-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/02/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Various techniques are used for spinal cord untethering. The purpose of this study was to compare patient characteristics, postoperative course, and early complications after laminotomy vs. laminoplasty for transection of the filum terminale for tethered cord release. METHODS Retrospective analysis of clinical and magnetic resonance imaging data was undertaken for all patients (<18 years) who underwent tethered cord release by transection of the filum terminale at Oregon Health & Science University, Doernbecher Children's Hospital, from 2000 to 2011. RESULTS Data from two hundred and forty-eight patients were analyzed. Mean age was 5.2 years (range 0.3 to 16.8 years). Access to the thecal space during surgery was achieved using laminotomy or laminoplasty in 82 (33.1 %) and 166 (66.9 %) patients, respectively. Laminoplasty patients were significantly younger than laminotomy patients (3.2 vs. 9.3 years, p<0.0001); other clinical and radiographic characteristics were similar between the groups. Nine patients (3.6 %) experienced early complications, including cerebrospinal fluid leak (n=2), suprafascial infection requiring surgical management and intravenous (IV) antibiotics (n=3) or IV antibiotics alone (n=1), a small area of peri-incisional cutaneous necrosis (n=1), perioperative seizures (n=1), and mild, transient malignant hyperthermia (n=1). There was no difference in the number of early complications between the two groups. Univariate and multivariate analyses revealed no significant risk factor for postoperative complication associated with technique. As judged by caregivers, independent of surgical technique, 97 % of patients improved after surgery. CONCLUSION There was no difference in complication risk when performing transection of the filum terminale for tethered cord release using laminotomy or laminoplasty.
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Affiliation(s)
- M J Strong
- Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, 97239, USA
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191
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Şimşek H, Çolak A. Answer to the Letter to the Editor of Hue Zhang concerning "A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle" by A. Colak et al. (2008) Eur Spine J; 17:1745-1751. Eur Spine J 2015; 24:1324-5. [PMID: 25822593 DOI: 10.1007/s00586-015-3909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Hakan Şimşek
- Department of Neurological Surgery, Johns Hopkins University Hospital, Meyer 8 181F, 600 North Wolfe Street, Baltimore, MD, 21287, USA,
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192
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Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane Database Syst Rev 2015:CD010036. [PMID: 25760812 DOI: 10.1002/14651858.cd010036.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The gold standard treatment for symptomatic lumbar stenosis refractory to conservative management is a facet-preserving laminectomy. New techniques of posterior decompression have been developed to preserve spinal integrity and to minimise tissue damage by limiting bony decompression and avoiding removal of the midline structures (i.e. spinous process, vertebral arch and interspinous and supraspinous ligaments). OBJECTIVES To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or avoid removal of posterior midline structures of the lumbar spine versus conventional facet-preserving laminectomy for the treatment of patients with degenerative lumbar stenosis. SEARCH METHODS An experienced librarian conducted a comprehensive electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) for relevant literature up to June 2014. SELECTION CRITERIA We included prospective controlled studies comparing conventional facet-preserving laminectomy versus a posterior decompressive technique that avoids removal of posterior midline structures or a technique involving only partial resection of the vertebral arch. We excluded studies describing techniques of decompression by means of interspinous process devices or concomitant (instrumented) fusion procedures. Participants included individuals with symptomatic degenerative lumbar stenosis only. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias using the Cochrane Back Review Group criteria for randomised controlled trials (RCTs) and the Newcastle-Ottawa Scale for non-randomised studies. We extracted data regarding demographics, intervention details and outcome measures. MAIN RESULTS A total of four high-quality RCTs and six low-quality RCTs met the search criteria of this review. These studies included a total of 733 participants. Investigators compared three different posterior decompression techniques versus conventional laminectomy. Three studies (173 participants) compared unilateral laminotomy for bilateral decompression versus conventional laminectomy. Four studies (382 participants) compared bilateral laminotomy versus conventional laminectomy (one study included three treatment groups and compared unilateral and bilateral laminotomy vs conventional laminectomy). Finally, four studies (218 participants) compared a split-spinous process laminotomy versus conventional laminectomy.Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in people who underwent bilateral laminotomy compared with conventional laminectomy (two RCTs, 223 participants, odds ratio 5.69, 95% confidence interval (CI) 2.55 to 12.71).Among the secondary outcome measures, unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low (three RCTs, 166 participants, odds ratio 0.28, 95% CI 0.07 to 1.15; three RCTs, 294 participants, odds ratio 0.10, 95% CI 0.02 to 0.55, respectively). The difference in severity of postoperative low back pain following bilateral laminotomy (two RCTs, 223 participants, mean difference -0.51, 95% CI -0.80 to -0.23) and split-spinous process laminotomy compared with conventional laminectomy (two RCTs, 97 participants, mean difference -1.07, 95% CI -2.15 to -0.00) was significantly less, but was too small to be clinically important. A quantitative comparison between unilateral laminotomy and conventional laminectomy was not possible because of different reporting of outcome measures. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. AUTHORS' CONCLUSIONS The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies. Future research is necessary to establish the incidence of iatrogenic instability using standardised definitions of radiological and clinical instability at comparable follow-up intervals. Long-term results with these techniques are currently lacking.
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Affiliation(s)
- Gijsbert M Overdevest
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, Leiden, Netherlands, 2300 RC
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Luzzati AD, Shah S, Gagliano F, Perrucchini G, Scotto G, Alloisio M. Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is challenging but rewarding. Clin Orthop Relat Res 2015; 473:858-67. [PMID: 24838759 PMCID: PMC4317411 DOI: 10.1007/s11999-014-3578-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms. QUESTIONS/PURPOSES Using data from a large spine tumor center, we answered the following questions: (1) Does multilevel total en bloc spondylectomy result in acceptable function, survival rates, and local control in spinal neoplasms? (2) Is reconstruction after this procedure feasible? (3) What complications are associated with this procedure? (4) is it possible to achieve adequate surgical margins with this procedure? METHODS We retrospectively investigated 38 patients undergoing multilevel total en bloc spondylectomy by a single surgeon (AL) from 1994 to 2011. Indications for this procedure were primary spinal sarcomas, solitary metastases, and aggressive primary benign tumors involving multiple segments of the thoracic or lumbar spine. Patients had to be medically fit and have no visceral metastases. Analysis was by chart and radiographic review. Margin quality was classified into intralesional, marginal, and wide. Radiographs, MR images, and CT scans were studied for local recurrence. Graft healing and instrumentation failures at subsequent followup were assessed. Complications were divided into major or minor and further classified as intraoperative and early and late postoperative. We evaluated the oncologic status using cumulative disease-specific and metastases-free survival analysis. Minimum followup was 24 months (mean, 39 months; range, 24-124 months). RESULTS Of the 38 patients, 34 (89%) were alive and walking without support at final followup. Thirty-one (81%) had no evidence of disease. Two patients died postoperatively and another two died of systemic disease (without local recurrence). Only three patients (8%) had a local recurrence. There were 14 major complications and 22 minor complications in 25 patients (65%). Only one patient required revision of implants secondary to mechanical failure. Two cases of cage subsidence were noted but had no clinical significance. Wide margins were achieved in nine patients (23%), marginal in 25 (66%), and intralesional in four (11%). CONCLUSIONS In patients with multisegmental spinal tumors, oncologic resections were achieved by multilevel en bloc spondylectomy and led to an acceptable survival rate with reasonable local control. Multilevel en bloc surgery was associated with a high complication rate; however, most patients recovered from their complications. Although the surgical procedure is challenging, our encouraging mid-term results clearly favor and validate this technique. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alessandro Davide Luzzati
- Section for Oncological Orthopaedics and Reconstruction of the Spine, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4-20161, Milan, Italy,
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194
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Dai F, Liu Y, Zhang F, Sun D, Luo F, Zhang Z, Xu J. Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients. Clinics (Sao Paulo) 2015; 70:114-9. [PMID: 25789520 PMCID: PMC4351308 DOI: 10.6061/clinics/2015(02)08] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws. METHODS Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5) underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter. RESULTS All patients were followed for a mean of 15.7 ± 5.6 months (range, 6 to 35 months). The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018) and an improvement in lower extremity function (p = 0.025) in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent. CONCLUSIONS The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery.
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Affiliation(s)
- Fei Dai
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
| | - Yaoyao Liu
- Department of Spine Surgery, Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Fei Zhang
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
| | - Dong Sun
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
| | - Fei Luo
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
| | - Zehua Zhang
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
| | - Jianzhong Xu
- Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, The Third Military Medical University, Chongqing, China
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Kim HJ, Chun HJ, Kang KT, Lee HM, Chang BS, Lee CK, Yeom JS. Finite element analysis for comparison of spinous process osteotomies technique with conventional laminectomy as lumbar decompression procedure. Yonsei Med J 2015; 56:146-53. [PMID: 25510758 PMCID: PMC4276748 DOI: 10.3349/ymj.2015.56.1.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate and compare the biomechanical behavior of the lumbar spine after posterior decompression with the spinous process osteotomy (SPiO) technique or the conventional laminectomy (CL) technique using a finite element (FE) model. MATERIALS AND METHODS Three validated lumbar FE models (L2-5) which represented intact spine and two decompression models using SPiO and CL techniques at the L3-4 segment were developed. In each model, the ranges of motion, the maximal von Mises stress of the annulus fibrosus, and the intradiscal pressures at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) under 7.5 Nm moments were analyzed. Facet contact forces were also compared among three models under the extension and torsion moments. RESULTS Compared to the intact model, the CL and SPiO models had increased range of motion and annulus stress at both the index segment (L3-4) and the adjacent segments under flexion and torsion. However, the SPiO model demonstrated a reduced range of motion and annulus stress than the CL model. Both CL and SPiO models had an increase of facet contact force at the L3-4 segment under the torsion moment compared to that of the intact model. Under the extension moment, however, three models demonstrated a similar facet contact force even at the L3-4 model. CONCLUSION Both decompression methods lead to postoperative segmental instability compared to the intact model. However, SPiO technique leads to better segmental stability compared to the CL technique.
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Affiliation(s)
- Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Sun Y, Yan LQ, Liang Y, Li XL, Cao XJ, Lu C. Reduction of epidural scar adhesion by topical application of simvastatin after laminectomy in rats. Eur Rev Med Pharmacol Sci 2015; 19:3-8. [PMID: 25635968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Epidural scar adhesion is one of the major causes of the failed back surgery syndrome after laminectomy. Recent studies have shown that simvastatin has potent anti-fibrotic and anti-inflammatory properties. This study evaluates the effect of the topical application of simvastatin on reducing epidural scar adhesion after laminectomy in rats. MATERIALS AND METHODS Thirty-six male Sprague-Dawley rats were randomly divided into three groups: control, chitosan and simvastatin group. After laminectomy was performed at L1 level, simvastatin and chitosan were applied to the laminectomy sites. The control group received no additional treatment. Four weeks later, the rats were killed and the epidural adhesion was evaluated by macroscopic assessment, hydroxyproline content analysis and histological analysis. The number of fibroblasts and the optical density of the collagen were also determined. RESULTS The results showed that simvastatin could reduce epidural scar adhesion in rats. Little epidural adhesions were seen in the laminectomy sites treated with simvastatin. The hydroxyproline content, the number of fibroblasts and the optical density of the collagen in the simvastatin group were significantly less than those of the chitosan and control group. However, dense epidural adhesion was found in control group. CONCLUSIONS Topical application of simvastatin could reduce epidural scar adhesion after laminectomy in rats. Further research is necessary to determine the optimal dosage and the safety of simvastatin.
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Affiliation(s)
- Y Sun
- Department of Microbiology, Nanjing Medical University, Nanjing, China.
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197
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Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, Merk H, Godolias G, Ruetten S. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician 2015; 18:61-70. [PMID: 25675060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Extensive decompression with laminectomy, where appropriate, is often still described as the method of choice when operating on degenerative lumbar spinal stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the surgical advantages they offer and the benefits for rehabilitation. One key issue when operating on the spine was the development of instruments to provide sufficient bone resection under continuous visual control. This was achieved by using endoscopes for operations carried out in cases of spinal canal stenosis. OBJECTIVE This study of patients with degenerative lumbar central spinal stenosis compares the results of spinal decompression using the full-endoscopic interlaminar technique (FI) with a conventional microsurgical laminotomy technique (MI). STUDY DESIGN Prospective, randomized, controlled study. SETTINGS 135 patients with microsurgical or full-endoscopic decompression were followed up for 2 years. Alongside general and specific parameters, the following measuring instruments were also used for the investigation: Visual Analog Scale (VAS), German version of the North American Spine Society Instrument (NASS), Oswestry Low-Back-Pain-Disability Questionnaire (ODI). RESULTS Postoperatively 72 % of the patients no longer had leg pain or the pain was almost completely reduced and 21.2 % experienced occasional pain. The clinical results were the same in both groups. The rate of complications and revisions was significantly reduced in the FI Group. The full-endoscopic techniques brought advantages in the following areas: operation, complications, traumatization, rehabilitation. LIMITATIONS Lack of placebo control group. CONCLUSIONS The recorded results demonstrate that the full-endoscopic interlaminar bilateral decompression adopting a unilateral approach provides an adequate and safe supplement and alternative to the conventional microsurgical bilateral laminotomy technique when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.
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Affiliation(s)
- Martin Komp
- Center for Spine Surgery and Pain Therapy, Germany
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198
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Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF. Diagnosis and management of bow hunter's syndrome: 15-year experience at barrow neurological institute. World Neurosurg 2014; 82:733-8. [PMID: 24549025 DOI: 10.1016/j.wneu.2014.02.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/10/2013] [Accepted: 02/13/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Bow hunter's syndrome is a rare vascular phenomenon characterized by insufficiency of the posterior cerebral circulation induced by rotation of the head within normal physiologic range. The neurosurgical literature on evidence-based diagnosis and management of the disease is scarce, and reports are largely limited to case studies. METHODS A retrospective chart review was performed on all patients referred to Barrow Neurological Institute during the period 1999-2013 with signs and symptoms that were possibly indicative of bow hunter's syndrome. Demographic data from patient charts were collected, and the patients' imaging studies were reviewed. RESULTS There were 14 patients referred to Barrow Neurological Institute with symptoms concerning for bow hunter's syndrome, and 11 of these patients were confirmed to have dynamic vertebral artery compression on angiography. The location of compression was centered on C1-2 (50%) or C5-7 (50%). The compressed vertebral artery was typically the left artery (72.7%), and in 54.5% of cases, rotation of the head to the contralateral side produced symptomatic dynamic compression. Surgical decompression, via either an anterior (44.4%) or a posterior (55.6%) approach, was eventually performed in 9 patients. Decompression alone was performed in all cases; however, 1 patient developed cervical instability requiring an anterior cervical instrumented fusion 5 years later. CONCLUSIONS Decompression without fusion is a safe, reliable surgical option in patients with bow hunter's syndrome. Decompression is performed via a posterior approach for atlantoaxial vertebral artery compression and via an anterior approach for subaxial compression. Long-term complications include cervical instability, which may necessitate internal fixation and fusion.
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Affiliation(s)
- Hasan A Zaidi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shakeel A Chowdhry
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph M Zabramski
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Minamide A, Yoshida M, Yamada H, Nakagawa Y, Hashizume H, Iwasaki H, Tsutsui S. Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study. Eur Spine J 2014; 24:396-403. [PMID: 25341804 DOI: 10.1007/s00586-014-3599-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE To prospectively investigate the long-term clinical outcomes of microendoscopic laminotomy (MEL) in patients with lumbar spinal stenosis (LSS) with and without degenerative spondylolisthesis (DS). METHODS In total, 159 patients (mean age, 68 years) who had undergone MEL for single-level LSS at L4/5 at our institute were recruited and followed-up for 5 years. Patients with and without DS were assigned to the DS (n = 71) and control (n = 88) groups, respectively. In addition to slippage rate, Japanese orthopedic association (JOA), recovery rate, short-form 36 (SF-36), and Roland-Morris disability questionnaire (RDQ) values were evaluated preoperatively and 5 years postoperatively. All parameters were analyzed by Student's t test, with p < 0.05 considered statistically significant. RESULTS Of 159 patients, 12 were lost to follow-up (follow-up rate, 92.5%); moreover, 15 patients were excluded because of death, cerebral infarction, dementia, or terminal cancer. Thus, 132 patients (DS group: 61, control group: 71) were finally examined. No significant differences were found in preoperative JOA, JOA recovery rate, RDQ, and SF-36 values between groups. The slippage rate in the DS group was 18.1% preoperatively and 16.8% at 5 years postoperatively (p > 0.05). There was no significant increase in instability in those with DS following MEL. Progressive spinal instability was noted in six patients (9.8%) and five patients (7.0 %) in the DS and control groups, respectively (p > 0.05). Moreover, the success rate of MEL was good/excellent in 70%, fair in 20%, and poor in 10 % of patients in both groups. CONCLUSION MEL showed similar outcomes in patients with DS and in those without DS.
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Affiliation(s)
- Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan,
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Satter MR, Henry PT, Khan AI, Chowdhury Q, Hossain M, Kundu RK. Supratentorial glioblastoma multiforme metastasizing to the cervical spinal cord. Mymensingh Med J 2014; 23:806-810. [PMID: 25481607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cases of glioblastoma multiforme (GBM) metastasizing to the leptomeninges or the intramedullary spine are rare and their prognosis are relatively poor. We present a case of supratentorial glioblastoma WHO grade IV which was later diagnosed to have cervical intramedullary metastasis 7 months after the primary surgery.
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