Showing papers in "Journal of Spinal Disorders & Techniques in 2007"
TL;DR: At 24 months, cervical arthroplasty with the BRYAN Cervical Disc Prosthesis compares favorably with ACDF as defined by standard outcomes scores.
Abstract: Study DesignProspective, randomized, controlled. Level 1 evidence.ObjectiveTo report functional outcomes at 48 months follow-up on prospectively randomized patients to either the Bryan cervical disc prosthesis or anterior cervical discectomy and fusion (ACDF) at a single site.Summary of Background D
247 citations
TL;DR: This retrospective review confirmed the significant prevalence of facet joint pain in chronic spinal pain and the value and validity of controlled, comparative local anesthetic blocks in the diagnosis of facet Joint Pain.
Abstract: Study DesignA retrospective review.ObjectivesEvaluation of the prevalence of facet or zygapophysial joint pain in chronic spinal pain of cervical, thoracic, and lumbar origin by using controlled, comparative local anesthetic blocks and evaluation of false-positive rates of single blocks in the diagn
218 citations
TL;DR: Using thoracic pedicle screw instrumentation as the primary anchor, the Ponte procedure was successfully performed in 17 consecutive patients for Scheuermann kyphosis with no exclusions for the size or rigidity of the kYphosis.
Abstract: Study DesignCase series.ObjectiveTo examine a consecutive series of surgically treated Scheuermann kyphosis that had a posterior only procedure with segmental pedicle screw fixation and segmental Ponte osteotomies.Summary of Background DataThe gold standard for surgical treatment of Scheuermann kyph
192 citations
TL;DR: It is recommended that ASF should be the first choice of treatment for patients with significant ossification of the posterior longitudinal ligament and a hypermobile cervical spine and the addition of posterior instrumented fusion would be desirable for stabilizing the spine and decreasing damage to the spinal cord.
Abstract: ObjectiveWe compared the surgical outcome of anterior decompression with spinal fusion (ASF) with the surgical outcome of laminoplasty for patients with cervical myelopathy due to ossification of the posterior longitudinal ligament.MethodsThe study group comprised 19 ASF patients (A-group) and 40 la
150 citations
TL;DR: A growing number of interspinous process devices have been introduced to the lumbar spine implant market, ranging from treatment of degenerative spinal stenosis, discogenic low back pain, facet syndrome, disk herniations, and instability.
Abstract: A growing number of interspinous process devices have been introduced to the lumbar spine implant market Implant designs vary from static spacers to dynamized devices Furthermore, they are composed of a range of different materials including bone allograft, titanium, polyetheretherketone, and elastomeric compounds The common link between them is the mechanical goal of distracting the spinous processes to affect the intervertebral relationship In contrast, the purported clinical goals are more variable, ranging from treatment of degenerative spinal stenosis, discogenic low back pain, facet syndrome, disk herniations, and instability Though some clinical data exist for some of these devices, defining the indications for these minimally invasive procedures will be crucial Indications should emerge from thoughtful consideration of data from randomized controlled studies
128 citations
TL;DR: Ten of 110 patients undergoing multilevel laminectomies and noninstrumented fusions developed unintended incidental intraoperative durotomy attributed to OYL extending to/through the dura, postoperative scar/marked OYL (2 patients), and synovial cysts/marked oYL (5 patients).
Abstract: Study design A retrospective analysis of the frequency and etiology of dural tears (DT), defined as an unintended incidental intraoperative durotomy, occurring in 110 predominantly geriatric patients undergoing multilevel laminectomies with noninstrumented fusions. Objective To document the frequency and etiology of DT occurring in these older patients. Summary of background data The frequency and etiology of DT occurring in older patients are not well documented. Methods The clinical (including comorbidities), neurodiagnostic, surgical procedures, and Short-Form 36 outcomes (questionnaires administered preoperatively, and 3, 6, 12 mo postoperatively) were retrospectively analyzed for these 110 patients with/without DT. Results Intraoperative DT occurred in 10 of 110 patients. These patients were typically older (average 74 y with fistulas vs. 69 y old without fistulas), included a higher percentage of females (90% vs. 76%), and had undergone somewhat more extensive laminectomies (5.5 vs. 5.0 levels) with noninstrumented fusions (1.8 vs. 1.6 levels). Three factors seemed to contribute to DT. Marked ossification of the yellow ligament (OYL), documented in all 10 patients with DT, extended to and through the dura in 3 patients. For the 100 patients without DT, 57 exhibited moderate/hypertrophied yellow ligament and 22 showed marked OYL. Synovial cysts with marked OYL were observed in 5 of 10 patients with DT, whereas only 8 of 100 without DT had synovial cysts. Prior surgical scar, originally anticipated to be a major contributing factor to DT, was found in only 2 of 10 patients with DT (also with marked OYL) compared with 10% without DT. Short-Form 36 outcome data revealed improvement on 4 or 5 Health Scales over the first postoperative year for both populations. Conclusions Ten of 110 patients undergoing multilevel laminectomies and noninstrumented fusions developed unintended incidental DT attributed to OYL extending to/through the dura (3 patients), postoperative scar/marked OYL (2 patients), and synovial cysts/marked OYL (5 patients).
106 citations
TL;DR: Numerical results in terms of intradiscal pressure predicted that the intervertebral disc at the instrumented level was unloaded by 27% in flexion, by 51% in extension, and by 6% in axial rotation, while no variations in pressure were caused by the device in lateral bending.
Abstract: Target of the study was to predict the biomechanics of the instrumented and adjacent levels due to the insertion of the DIAM spinal stabilization system (Medtronic Ltd). For this purpose, a 3-dimensional finite element model of the intact L3/S1 segment was developed and subjected to different loading conditions (flexion, extension, lateral bending, axial rotation). The model was then instrumented at the L4/L5 level and the same loading conditions were reapplied. Within the assumptions of our model, the simulation results suggested that the implant caused a reduction in range of motion of the instrumented level by 17% in flexion and by 43% in extension, whereas at the adjacent levels, no significant changes were predicted. Numerical results in terms of intradiscal pressure, relative to the intact condition, predicted that the intervertebral disc at the instrumented level was unloaded by 27% in flexion, by 51% in extension, and by 6% in axial rotation, while no variations in pressure were caused by the device in lateral bending. At the adjacent levels, a change of relative intradiscal pressure was predicted in extension, both at the L3/L4 level, which resulted unloaded by 26% and at the L5/S1 level, unloaded by 8%. Furthermore, a reduction in terms of principal compressive stress in the annulus fibrosus of the L4/L5 instrumented level was predicted, as compared with the intact condition. These numerical predictions have to be regarded as a theoretical representation of the behavior of the spine, because any finite element model represents only a simplification of the real structure.
91 citations
TL;DR: The addition of intermediate screws at the level of a burst fracture significantly increases the stiffness of a short segment pedicular fixation.
Abstract: To determine the effect of adding pedicle screws at the level of a burst fracture (intermediate screws) on the stiffness of a short segment pedicle fixation, an in vitro biomechanical study was carried out. Six fresh-frozen pig lumbar spine specimens were used. The flexibility of the intact specimen
82 citations
TL;DR: Changes of pulmonary function of 30 older women who suffered from OVCFs in the thoracolumbar segment after kyphoplasty are explored, finding decreased values of pain scores had a remarkably positive correlation with the percentage of improvement of FVC and MVV measured 3 days after the procedures.
Abstract: One of the consequences of osteoporotic vertebral compression fractures (OVCFs) is progressive collapse of the fractured osteoporotic vertebral body. This can lead to spinal kyphosis that may cause restriction of respiratory function. The balloon kyphoplasty procedure can reduce kyphosis and relieve the pain. There are few studies that have appropriate data and follow-up to evaluate the effect of deformity correction on pulmonary function after the kyphoplasty procedure. The current study explores changes of pulmonary function of 30 older women who suffered from OVCFs in the thoracolumbar segment after kyphoplasty. After kyphoplasty was performed on these women, thoracic kyphotic angle, local kyphotic angle, pain scores, and pulmonary function parameters-vital capacity, inspiratory capacity, residual volume, functional residual capacity, total lung capacity, forced vital capacity (FVC), and maximum voluntary ventilation (MVV) were measured. All measurements were taken before, 3 days after, and 1 month after the kyphoplasty. The height of the vertebral body was restored, the local kyphotic angle was improved, and pain scores were significantly decreased after kyphoplasty. FVC and MVV were significantly increased 3 days after the procedures; whereas only MVV had gone on to improve 1 month later. The decreased values of pain scores had a remarkably positive correlation with the percentage of improvement of FVC (r=0.536) and MVV (r=0.614) measured 3 days after kyphoplasty. In patients with OVCFs, kyphoplasty could partially improve their impaired lung function.
79 citations
TL;DR: In this article, direct C1 lateral mass/C2 pars or pedicle screw fixation has been proposed as an alternative method to C1-C2 transarticular screw fixation.
Abstract: ObjectivesDirect C1 lateral mass/C2 pars or pedicle screw fixation has been recently proposed as an alternative method to C1-C2 transarticular screw fixation. Although this method seems attractive, there are currently limited clinical data on the use of this technique for multilevel fixation includi
76 citations
TL;DR: A retrospective review of case notes and whole spine MRI studies of all acute spinal infection cases that presented to a regional Spinal Unit over 3 years found the incidence of multiple level noncontiguous vertebral tuberculosis was higher than previously quoted when MRI is not undertaken.
Abstract: The commonest site of osseous tuberculosis is the spine. Most vertebral lesions are contiguous. Current research indicates the incidence of multiple level noncontiguous vertebral tuberculosis is 1.1% to 16%. The aim of this study was to identify the incidence of multiple level noncontiguous vertebral tuberculosis using whole spine magnetic resonance imaging (MRI). A retrospective review was undertaken of case notes and whole spine MRI studies of all acute spinal infection cases that presented to a regional Spinal Unit over 3 years. Patients were included if spinal infection was identified by whole spine MRI and confirmed as tuberculosis by a combination of histology and microbiology. The incidence of multiple level noncontiguous vertebral tuberculosis was 71.4%. This is higher than previously quoted when MRI is not undertaken. Tuberculosis may affect the spine at multiple noncontiguous sites more frequently than thought previously. A large proportion of the affected noncontiguous sites may also be asymptomatic. We currently perform whole spine MRI on all patients with suspected spinal infection to aid detection of multiple level noncontiguous tuberculosis.
TL;DR: The current Wallis implant is probably incapable of reducing the incidence of recurrent herniations, but it still may be useful in patients with discogenic back pain due to early degenerative disc disease.
Abstract: Background Ipsilateral recurrent disc herniation after lumbar discectomy is a significant problem in the management of lumbar disc disease and may necessitate repeat surgical intervention. A population-based study in Finland found that about 14% of all primary lumbar discectomies required additional surgical interventions. Interspinous devices, which have been shown to unload the posterior anulus, may reduce the occurrence of recurrent herniations. We report our short-term experience with the use of the Wallis device in the management of patients with lumbar disc herniation undergoing primary disc excision. Patients and methods Thirty-seven consecutive patients (23 males and 14 females, average age 36 y) underwent primary lumbar disc excision followed by fixation of the segment with the Wallis implant during a period of 1 year. Indications for implanting the Wallis device were a voluminous disc herniation and preservation of at least 50% of disc space height. Surgery was performed at level L4-5 in most patients. Average follow-up after surgery was 16 months (range 12 to 24). The last 14 patients were also evaluated by the preoperative and postoperative Oswestry Disability Index (ODI) questionnaire, the SF-36 survey, and by a visual analog scale (VAS) for back and leg pain. Results The average ODI dropped from 43 to 12.7. The average VAS for back pain dropped from 6.6 to1.4 and the average Vas for leg pain dropped from 8.2 to 1.5. Five patients (4 males and 1 female) with relapsing leg pain were diagnosed by contrast-enhanced magnetic resonance imaging as suffering from recurrent herniation (5/37, 13%). All reherniations occurred at level L4-5 level between 1 and 9 months after the index surgery. Two of the 5 patients subsequently underwent additional discectomy and fusion. Summary The current Wallis implant is probably incapable of reducing the incidence of recurrent herniations, but it still may be useful in patients with discogenic back pain due to early degenerative disc disease.
TL;DR: Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.
Abstract: Study DesignA retrospective clinical study of 1-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region (MTSUTR).ObjectiveMTSUTR has rarely been documented in the literature. We present a retrospective clinical study of 23 patients with MTSUTR treated by anterio
TL;DR: Computer-assisted surgery allows for more accurate placement of pedicle screws at the CTJ andPedicle screw accuracy was significantly improved with computer-assisted techniques, but there was no significant difference between the 2-dimensional and 3-dimensional techniques.
Abstract: ObjectivePosterior transpedicular fixation at the cervicothoracic junction (CTJ) is increasing in popularity. However, the clinical accuracy of pedicle screw placement at the CTJ has not been specifically assessed.MethodsBetween January 2000 and July 2004, 60 consecutive patients underwent a variety
TL;DR: In cases of postoperative deep wound infection after PLIF with cages, removal of the interbody implants is not necessary and treatment is composed of prolonged antibiotic therapy guided by antimicrobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.
Abstract: ObjectivesTo evaluate long-term treatment outcome of patients with infected posterior lumbar interbody fusion (PLIF) managed with surgical debridement and or prolonged antiobiotic treatment without removal of the interbody cages.MethodsBetween 1996 and 1999, 8 out of 111 patients who underwent PLIF
TL;DR: Rec retrospective database analysis of 105 patients undergoing posterior L5-S1 spine fusion with pedicle screw instrumentation for isthmic spondylolisthesis with and without the use of fluoroscopy-based image guidance found image-guided spinal surgery did not cause an increase in operative time.
Abstract: Objective: To review the operative time differences between computer-assisted spinal navigation versus serial radiography. Summary of Background Data: There have been multiple studies describing the use of computer-assisted image guided surgery (IGS) in the application of spinal instrumentation. AQ2 Techniques have evolved to allow attainment of multilevel visualization intraoperatively both successfully and safely. These have proven to result in low screw misplacement rates, low incidence of radiation exposure and excellent operative field viewing. As a result, image guidance has become an increasingly accepted and practiced form of intraoperative spinal navigation. However, potential limitations to IGS have been described including longer operating times. Many studies have looked at the success of beneficial outcomes; however, none to our knowledge have reviewed such described operative time increments with IGS. Methods: The authors performed a retrospective database analysis of 105 patients undergoing posterior L5-S1 spine fusion with pedicle screw instrumentation for isthmic spondylolisthesis with and without the use of fluoroscopy-based image guidance. This was followed by a chart review of anesthesia operative time documentation. Subsequent time calculations and statistical analysis were performed for comparison. Results: Computer-assisted image-guided spine surgery has overall demonstrated shorter mean operative times when compared with intraoperative serial radiography technique; an average of 40 minutes less per case (P<0.001). There is also less variation in operative times using image guidance, with 13 of 43 (30%) cases using serial x-ray lasting more than 3.75 hours compared with none of the 57 done via image guidance (P<0.001). The operative duration for both procedures trended downward over time. For both procedural cohorts operating room time continued to decrease as of the most recent year being performed. Lastly, in an attempt to minimize such a confounding factor as a learning curve, the last 20 cases in each group were compared. There was an average difference of about 22 minutes less for the image guidance group but missed being statistically significant (P = 0.0503). Conclusions: Image-guided spinal surgery did not cause an increase in operative time. In the best scenario, image navigation saved a statistically significant (P<0.001) amount of time in the operating room. At its worst, fluoroscopy-based image-guided navigation is not significantly different from standard serial radiography.
TL;DR: The SPLV was the only surgical approach to demonstrate a statistically significant improvement in Eastern Cooperative Oncology Group scores at 3 months after the surgery and should be considered in all cases where resection of thoracic or lumbar spinal metastatic disease and reconstruction is contemplated.
Abstract: Appropriate surgical management of spinal metastases combines maximal neural decompression with simultaneous immediate spinal column stabilization in the context of a paliative operation undertaken to improve patients' quality of life. We have used a single-stage posterolateral vertebrectomy (SPLV) for disease of the lumbar spine, combined with bilateral costotransversectomies in the thoracic spine, for these challenging cases. In this prospective cohort study of 96 consecutive patients with metastatic disease of the spinal column for we describe our surgical technique in detail, we examine our learning curve in its use and we analyze the long-term surgical and "quality of life" results in 42 patients who underwent SPLV. The mean and maximum operative blood loss was significantly lower for the SPLV group when compared with combined approaches. All patients either remained neurologically stable or had improved with surgery. Both the mean and the range visual analog scale scores were significantly improved after the SPLV. The SPLV was the only surgical approach to demonstrate a statistically significant improvement in Eastern Cooperative Oncology Group scores at 3 months after the surgery. Seventy-five percent of patients were alive at 6 months and 50% of patients survived for more than 12 months after the surgery. Eleven patients had a major complication (26%) with 9 (21%) patients required early reoperation, 7 of them for wound failure. Our data demonstrates that the SPLV represents a technically achievable improvement in surgical approach to spinal metastases when key parameters are examined. On the basis of these results, we recommend that the SPLV should be considered in all cases where resection of thoracic or lumbar spinal metastatic disease and reconstruction is contemplated.
TL;DR: Either a multilevel discectomy and cage fusion with plate fixation or a corpectomy and iliac bone fusion with plating provides good clinical results and similar fusion rates for cervical degenerative disc disease.
Abstract: Study DesignClinical and radiologic study evaluating the outcome after anterior corpectomy with iliac bone fusion compared with discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease.ObjectivesTo investigate the safety and effectiveness of interbody titanium
TL;DR: An increasing severity of kyphosis was associated with a significant increase in respiratory impairment, and a more cranial level of the kYphosis had a significantly greater effect on respiratory impairment.
Abstract: ObjectiveTo quantify the respiratory compromise in patients with a congenital kyphosis or kyphoscoliosis in whom the major deformity is the kyphosis.MethodsForty-one patients with congenital vertebral anomalies resulting in a kyphosis or kyphoscoliosis, in which the kyphosis was the major deformity,
TL;DR: This preliminary study shows the efficacy and inocuity of this new substance that could take over the Chymopapain therapeutic field.
Abstract: Study DesignProspective clinical trial.ObjectiveDemonstrate the safety and efficacy of gelified ethanol in the percutaneous treatment of lumbar disk hernias.Summary of Background DataAfter the commercial withdrawal of Chymopapain, the need for new substances to treat intervertebral disk hernias was
TL;DR: Lumbar circumferential arthrodesis using PEEK cages provided good clinical results and fusion rate, however, lordosis correction was not maintained at follow-up, especially at lower levels, using high cages, in older patients, and when associated with a rigid primary posterior instrumentation.
Abstract: Usual interbody cages at the lumbar spine are made of titanium or carbon fiber-polyetheretherketone (PEEK). Pure PEEK cages have more recently been proposed for its lower elasticity modulus. The goal of our study was to investigate a series of patients with circumferential fixation using anterior PE
TL;DR: This study identified which, if any, of a range of patient and surgical variables may contribute significantly to postoperative FSU malalignment, particularly those leading to loss of disc space height and affecting annular tension.
Abstract: Part 1 of the current study found that use of the Bryan Cervical Disc prosthesis resulted in a median loss of 2 degrees in functional spinal unit (FSU) lordosis when compared with preoperative imaging (P<0.0001, range: 8-degree loss to 5-degree gain). The observed changes were generally small but va
TL;DR: Rather than aborting the procedure, a technique is devised, called the eggshell technique, to manage the patient's fracture once extravasation is noted so that the procedure can be safely completed.
Abstract: Cement extravasation during kyphoplasty occurs between 4% and 9%, a much lower incidence than with vertebroplasty. However, because of the potential complications of cement in and around the spinal canal, any egress of cement outside the vertebral body is extremely concerning. Aborting the procedure will cease the extraosseous leakage and minimize potential immediate complications. However, the cavity will remain unfilled and the fracture unstable. Rather than aborting, we have devised a technique, called the eggshell technique, to manage the patient's fracture once extravasation is noted so that the procedure can be safely completed.
TL;DR: Fusion and clinical success rates were not diminished by the use of a unilateral interbody cage rather than the recommended 2 cages and disc space height and foraminal height were restored by the surgery and maintained at last follow-up.
Abstract: Posterior lumbar interbody fusion (PLIF), as recommended with bilateral lumbar interbody cages and pedicle screw fixation, has increased the successful fusion rate to nearly 100%. Presently, a unilateral approach to the disc space with a variant of PLIF, the trans-foraminal interbody fusion is often used. There are few clinical studies of unilateral interbody fusion. The clinical and fusion results of unilateral interbody fusion are important as the usage of trans-foraminal interbody fusion procedure increases. This retrospective study of 26 consecutive patients treated with a unilateral cage asks whether fusion healing and clinical outcome is comparable with that obtained with bilateral cages. In this study, there were no pseudarthroses, instrumentation failures, or significant subsidence at any of the single cage levels. Disc space height and foraminal height were restored by the surgery and maintained at last follow-up. Using Prolo scores, 23/26 patients had clinical success (88%), and 3 were unsuccessful. Fusion was successful at all single cage fusion levels and overall in 23/26 (88%) reviewing all levels of fusion. In conclusion, fusion and clinical success rates were not diminished by the use of a unilateral interbody cage rather than the recommended 2 cages. This retrospective comparative study is a Level III-2 Therapeutic Study investigating the results of unilateral PLIF with a single interbody cage compared with historical series with interbody cages.
TL;DR: The tethering effect on the root seemed to be the main pathogenic mechanism of C5 root palsies in this study, and there was no significant positive correlation with an increase in T2-weighted hyperintense foci on magnetic resonance studies.
Abstract: OBJECTIVE To investigate the imaging findings correlated with C5 root palsies in the patients undergoing laminectomy and lateral mass screw fixation for ossification of posterior longitudinal ligament (OPLL), and clarify its pathogenic mechanism. METHODS The series included 49 patients with OPLL. Characteristics of preoperative and postoperative x-ray, computed tomography, and magnetic resonance images were compared between the patients with and those without C5 root palsies. RESULTS Postoperative C5 root palsies occurred in 9 patients 6 to 64 hours postoperatively. They tended to have increased cervical lordosis and severe OPLL. However, there was no significant positive correlation with an increase in T2-weighted hyperintense foci on magnetic resonance studies. CONCLUSIONS The tethering effect on the root seemed to be the main pathogenic mechanism of C5 root palsies in this study.
TL;DR: This procedure is considered as a potential alternative to 2-level anterior cervical discectomy and fusion or open foraminotomy in selected patients and can be safely performed on an outpatient basis with results comparable to that of conventional foraminectomy.
Abstract: IntroductionThe management of cervical radiculopathy has undergone significant evolution, and the most recent advancement is the integration of minimally invasive surgical techniques. There have been relatively few reports in the medical literature describing the clinical results of minimally invasi
TL;DR: Spinal canal dimension is not predictive of success or failure of ESI in patients with spinal stenosis and there was no statistically significant difference in the minimum measurement in any dimension between the surgical and the nonsurgical group.
Abstract: PurposeTo determine a critical canal dimension in patients with spinal stenosis that predicts response to epidural steroid injections (ESI).MethodsLumbar spinal stenosis patients with a computed tomography scan before ESI were identified through ICD-9/CPT codes. Using a digital caliper, canal dimens
TL;DR: This modified laminoplasty preserving the semispinalis cervicis inserted into C2 is an effective procedure for maintaining postoperative ROM, especially in extension, and sagittal alignment of the upper cervical spine well.
Abstract: STUDY DESIGN A radiographic study in 111 patients using radiographs was conducted. OBJECTIVE To clarify whether the modified laminoplasty with C3 laminectomy preserving the semispinalis cervicis (SSC) inserted into C2 could maintain the postopertive range of motion (ROM) and sagittal alignment compared with conventional C3-C7 laminoplasty reattaching the muscle to C2. SUMMARY OF BACKGROUND DATA Intraoperative injury of the SSC is relevant to the significant loss of ROM and the malalignment after laminoplasty. To expose the C3 lamina, however, the SSC inserted into C2 could not be preserved in conventional C3-C7 laminoplasty. METHODS The ROM and sagittal alignment of 70 patients (group A) (52 men, 18 women, mean age 59 y, mean follow-up period 1 y and 7 mo) with C4-C7 laminoplasty with C3 laminectomy were compared with those of 41 patients (group B) (28 men, 13 women, mean age 59 y, mean follow-up period 2 y and 6 mo) with C3-C7 laminoplasty using radiographs of the cervical spine. RESULTS Regarding C2-C7 ROM, the postoperative ROM was larger (P=0.003) and the decrease rate of ROM was smaller (P=0.0006), and decreased ROM in extension was smaller (P<0.0001) in group A. Regarding O-C2 ROM, the increased ROM was smaller (P=0.043) and increased ROM in extension was smaller (P=0.001) in group A. Regarding O-C7 ROM, the postoperative ROM was larger (P=0.029) in group A. Regarding the cervical alignment, the increased lordotic angle at O-C2 was smaller (P=0.046) in group A. CONCLUSIONS This modified laminoplasty preserving the SSC inserted into C2 is an effective procedure for maintaining postoperative ROM, especially in extension, and sagittal alignment of the upper cervical spine well.
TL;DR: PLIF using a titanium cage filled with excised facet joint bone and a pedicle screw provided a satisfactory clinical outcome and an excellent union rate without harvesting and grafting the autologous iliac bone.
Abstract: OBJECTIVES To determine the validity of posterior lumbar interbody fusion (PLIF) using a titanium cage filled with excised facet joint bone and a pedicle screw for degenerative spondylolisthesis. METHODS PLIF using a titanium cage filled with excised facet joint bone and a pedicle screw was performed in 28 consecutive patients (men 10, women 18). The mean age of the patients was 60 years (range, 52 to 75 y) at the time of surgery. The mean follow-up period was 2.3 years (range, 2.0 to 4.5 y). The operation was done at L3/4 in 5, L4/5 in 20, and L3/4/5 in 3 patients. The mean operative bleeding was 318+/-151 g (mean+/-standard deviation), and the mean operative time was 3.34+/-0.57 hours per fixed segment. Clinical outcome was assessed by Denis' Pain and Work scale. Radiologic assessment was done using Boxell's method. Fusion outcome was assessed using an established criteria. RESULTS On Pain scale, 20 and 8 patients were rated P4 and P5 before surgery, and 11, 12, 2, 2, and 1 patients were rated P1, P2, P3, P4, and P5 at final follow-up, respectively. On Work scale (for only physical labors), 12 and 9 patients were rated W4 and W5, before surgery, and 12, 5, 1, and 3 patients were rated W1, W2, W3 and W5 at final follow-up, respectively. There was significant difference in clinical outcome (P<0.01, Wilcoxon singled-rank test) The mean %Slip and Slip Angle was 17.9+/-8.1% and 3.9+/-5.8 degrees before surgery. The mean % Slip and Slip Angle was 5.4+/-4.4% and -2.0+/-4.8 degrees at final follow-up. There was a significant difference between the values (P<0.01, paired t test). "Union" and "probable union" was determined in 29 (93.5%) and 2 (6.5%) of 31 operated segments at 2.3 years (range, 2.0 to 4.5 y), postoperatively. CONCLUSIONS PLIF using a titanium cage filled with excised facet joint bone and a pedicle screw provided a satisfactory clinical outcome and an excellent union rate without harvesting and grafting the autologous iliac bone.
TL;DR: The authors evaluated the time required for paired points and surface matching registration when using the BrainLAB (BrainLAB, Westchester, IL) image-guided spine application for spinal surgery cases and found it was less than 2 minutes.
Abstract: Image-guidance can increase the safety and accuracy of spinal instrumentation placement. However, many spine surgeons are reluctant to incorporate spinal image-guidance into their surgical practice due to the perception that it is time-consuming and tedious, especially the task of vertebral registration. The authors evaluated the time required for paired points and surface matching registration when using the BrainLAB (BrainLAB, Westchester, IL) image-guided spine application for spinal surgery cases. The time required to register vertebral segments using paired points and surface matching techniques was assessed in 13 consecutive patients undergoing spinal fusions by the senior author. Overall, 23 vertebral segments were registered spanning from T1 to S1. Note was made of the vertebral segments that required reregistration due to poor accuracy. The average time required to register a single vertebral segment using the paired points and surface matching technique was 117 seconds (1 min 57 s). Average accuracy obtained was 0.9 mm. Inaccurate registration occurred in 3/23 (13%) of the segments requiring a second attempt at registration. In 3/23 (13%) of segments, adequate navigation accuracy was maintained on an adjacent vertebral segment thereby allowing for instrumentation to be placed in that adjacent segment without having to register that segment. Though associated with a learning curve, image-guidance can be used effectively and efficiently in spinal surgery. Average time required for registration of a vertebral segment using the BrainLAB spine application in this study was less than 2 minutes. The average accuracy obtained was 0.9 mm.