The Michel Benoist and Robert Mulholland yearly European spine journal review: a survey of the "surgical and research" articles in the European spine journal, 2015

Therapeutic Effects and Finite Element Analysis of a Combined Treatment Using Laser Needle-Knife with Supine Repositioning Massage on Patients with Cervical Spondylotic Vertebral Arteriopathy

Objective: To investigate the effectiveness of combined laser needle-knife and massage on cervical spondylotic vertebral arteriopathy patients. Summary of background data: With the recent rise of electronic businesses, the incidence of cervical spondylosis has also risen rapidly. Methods: Cervical spondylotic vertebral arteriopathy patients were treated using laser needle-knife with massage, and compared to patients who only received the massage. A 3D anatomical and hemodynamic model was developed. Results: The symptomatic and functional overall scores were reduced by 71.43% after the combined treatment. Results from the finite element analysis indicated that the maximum flow rate of the left vertebral artery was improved by 47.52% and the right was improved by 38.67%. Conclusion: A combined treatment of cervical spondylotic vertebral arteriopathy using laser needle-knife and massage is an effective approach with a therapeutic mechanism closely related to hemodynamics.

The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients

PURPOSE

Incidental durotomy is one of the most common complications in lumbar spine surgery. There are conflicting reports whether a dural lesion is associated with an inferior outcome after lumbar decompression. This study analyzed the effect of incidental durotomy in this specific group of patients (Dura+) and compared the results with the remaining cohort without dural laceration (Dura-).

METHODS

This prospective multi-center study included 800 patients with lumbar spinal stenosis who underwent exclusive decompression surgery. All procedures were performed as part of a multi-center investigation at three highly specialized spine clinics. Outcome measures (ODI, EQ5D, VAS_{back pain} and VAS_{leg pain}) were obtained preoperatively as well as 3 and 12 months after surgery. The effect of an incidental durotomy on the clinical outcomes was analyzed statistically between the two cohorts.

RESULTS

An intraoperative dura lesion was recorded in 6.5 % (n = 52/800) of all cases. Both cohorts (Dura+ and Dura-) did not reveal any differences regarding patient demographics, risk factors, or co-morbidities at baseline. The length of the hospital stay was significantly longer for the Dura+ cohort (8.0 vs. 6.4 days; p < 0.01). After 12 months, the Dura- cohort demonstrated a significantly greater improvement in VAS_{back pain} in comparison to the Dura+ cohort (Δ21.4 vs. Δ7.2 points; p < 0.05). The differences for the remaining outcome measures were not statistically significant (p > 0.05).

CONCLUSIONS

The results of this study reveal that an incidental durotomy was associated with a significant increase in the patient's length of stay, and risk for re-intervention for the treatment of persisting CSF leakage. In contrast to previous reports which have investigated the effects of incidental durotomies on the clinical outcome after lumbar decompression surgery, our data further suggest a possible inferior outcome in terms of low back pain improvement in the Dura+ cohort, which became clinically apparent at the 12-month follow-up period. Future studies should investigate whether a more pronounced decompression required for adequate exposure and repair of a dural laceration may, ultimately, result in increased segmental instability and in clinically undesirable low back pain.