A review of neurophysiological testing

Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion

BACKGROUND CONTEXT

Revision posterior decompression and fusion surgery for patients with symptomatic adjacent segment degeneration (ASD) is associated with significant morbidity and is technically challenging. The use of a stand-alone lateral lumbar interbody fusion (LLIF) in patients with symptomatic ASD may prevent many of the complications associated with revision posterior surgery.

PURPOSE

The objective of this study was to assess the clinical and radiographic outcomes of patients who underwent stand-alone LLIF for symptomatic ASD.

STUDY DESIGN

This is a retrospective case series.

PATIENT SAMPLE

We retrospectively reviewed patients with a prior posterior instrumented fusion who underwent a subsequent stand-alone LLIF for ASD by a single surgeon. All patients had at least 18 months of follow-up. Patients were diagnosed with symptomatic ASD if they had a previous lumbar fusion with the subsequent development of back pain, neurogenic claudication, or lower extremity radiculopathy in the setting of imaging, which demonstrated stenosis, spondylolisthesis, kyphosis, or scoliosis at the adjacent level.

OUTCOME MEASURES

Patient-reported outcomes were obtained at preoperative and final follow-up visits using the Oswestry Disability Index [ODI], visual analog scale (VAS)-back, and VAS-leg. Radiographic parameters were measured, including segmental and overall lordoses, pelvic incidence-lumbar lordosis mismatch, coronal alignment, and intervertebral disc height.

METHODS

Clinical and radiographic outcomes were compared between preoperative and final follow-up using paired t tests.

RESULTS

Twenty-five patients met inclusion criteria. The mean age was 62.0±11.3 years. The average follow-up was 34.8±22.4 months. Fifteen (60%) underwent stand-alone LLIF surgery for radicular leg pain, 7 (28%) for symptoms of claudication, and 25 (100.0%) for severe back pain. Oswestry Disability Index scores significantly improved from preoperative values (46.6±16.4) to final follow-up (30.4±16.8, p=.002). Visual analog scale-back (preop 8.4±1.0, postop 3.2±1.9; p<.001), and VAS-leg (preop 3.6±3.4, postop 1.9±2.6; p<.001) scores significantly improved following surgery. Segmental and regional lordoses, as well as intervertebral disc height, significantly improved (p<.001) and remained stable (p=.004) by the surgery. Pelvic incidence-lumbar lordosis mismatch significantly improved at the first postoperative visit (p=.029) and was largely maintained at the most recent follow-up (p=.45). Six patients suffered from new-onset thigh weakness following LLIF surgery, but all showed complete resolution within 6 weeks. Three patients required subsequent additional surgeries, all of which were revised to include posterior instrumentation.

CONCLUSIONS

Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with symptomatic ASD following a previous lumbar fusion.

Discrimination of differences in digitally manipulated phoneme length during speech

The present study investigated differences in the thresholds of phoneme duration in word and sentence contexts by participants' sex. In the word condition, 27 participants listened to two pairs of words in a dual pair discrimination task. One pair contained the same durations of /s/, and the other pair contained different durations of /s/. Participants were to select the pair which contained different durations of /s/ in the words. In the sentence condition, the other set of 27 participants listened to two pairs of sentences and selected the pair containing different durations of /s/ in the sentences. Throughout these tasks, the participants' just-noticeable-difference and trials-to-completion were analyzed. The results showed that the participants demonstrated better performance in detecting just-noticeable-difference in the sentence condition than in the word condition. In addition, a sex difference was found in just-noticeable-difference in both conditions with better performance in men than women. No significant differences in trials-to-completion were found in either condition.

Intraoperative neurophysiological monitoring technology: recent advances and evolving uses

Intraoperative neurophysiological monitoring has evolved over the last 25 years to become an important component of many types of orthopedic and neurosurgical procedures. From its foundations in VIII cranial nerve surgeries and scoliosis corrections surgeries, intraoperative neurophysiological monitoring has expanded to incorporate nearly all spine procedures and many involving the brain and brainstem. Fundamental to this growth in the use of intraoperative neurophysiological monitoring has been the development of the technology used to perform the neurophysiological tests. Advancements in electronics and computer technology have resulted in significant improvements in the capacity, ease of use, quality and reliability of the equipment as well as the quality of and control over the acquired data. These technological advancements have resulted in remarkable improvements in not only the quality and availability of intraoperative neurophysiological monitoring, but also, as a consequence, patient care, and have arguably propelled the expansion of the use that intraoperative neurophysiological monitoring has seen over the last 10 years.

Carpal tunnel syndrome--a comprehensive review

PURPOSE

To provide a comprehensive review of the management of carpal tunnel syndrome.

METHODS AND RESULTS

A systematic literature review is provided of the history, anatomy, pathophysiology, epidemiology, diagnostic criteria, investigative surgical techniques, results and complications for carpal tunnel syndrome.

CONCLUSION

Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided.