Journal of spinal disorders & techniques
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J Spinal Disord Tech · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialCorrelative analysis of the results of surgical treatment of thoracolumbar injuries with long Texas Scottish rite hospital construct: is the use of pedicle screws versus hooks advantageous in the lumbar spine?
This is a prospective, randomized study to compare the efficacy of two similar "long-segment" Texas Scottish Rite Hospital instrumentations with the use of hooks in the thoracic spine and pedicle screws versus laminar hook claw in the lumbar spine for thoracolumbar A3, B, and C injuries. Forty consecutive patients with such thoracolumbar fractures (T11-L1) associated with spinal canal encroachment underwent early operative postural reduction and stabilization. The patients were randomly sampled into two groups: Twenty patients received hooks in "claw configuration" in both the thoracic and the lumbar spine (group A), and 20 patients received hooks in the thoracic vertebrae and pedicle screws in the lumbar vertebrae (group B). ⋯ There was neither pseudarthrosis nor neurologic deterioration following surgery. Visual Analog Pain Scale and Short Form-36 scores were equally improved and did not differ between the two groups. The use of pedicle screws in the lumbar spine to stabilize the lowermost end of a long rigid construct applied for A3, B, and C thoracolumbar injuries was advantageous when compared with that using hook claws in the lumbar spine because the constructs with screws restored and maintained the fractured anterior vertebral body height better than the hooks without subsequent loss of correction and safeguarded postoperatively a continuous SCC at the injury level.
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J Spinal Disord Tech · Jun 2004
Posterior spinal fusion for lumbar degenerative diseases using the Crock-Yamagishi (C-Y) spinal fixation system.
Although many transpedicular screw systems have been developed and have undergone wide clinical use, experience with semirigid transpedicular systems has rarely been reported. We evaluated the efficacy and safety of the Crock-Yamagishi (C-Y) system for posterior spinal fusion in lumbar degenerative diseases. The outcomes for 26 patients (14 men, 12 women) with lumbar degenerative diseases who underwent posterior spinal fusion using the C-Y system were analyzed (posterior lumbar interbody fusion (PLIF), 11 patients; posterolateral fusion (PLF), 14; and facet fusion (FF), 1. ⋯ Neither breakage nor loosening of implants was observed radiographically. Intra- and postoperative complications included one case of transient L5 nerve root palsy attributable to surgical technique, and one deep postoperative infection. The C-Y system, categorized as semirigid, is effective when used with one- or two-level PLIF or PLF for lumbar degenerative disorders, grade I to II spondylolisthesis, and failed back syndrome.
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J Spinal Disord Tech · Jun 2004
The course of the nerve root in the neural foramen and its relationship with foraminal entrapment or impingement in adult patients with lumbar isthmic spondylolisthesis and radicular pain.
The purpose of this study was to demonstrate the course of a nerve root in the neural foramen and its relationship with foraminal entrapment or impingement in 19 adult patients with isthmic spondylolisthesis and radicular pain. Myelo-computed tomography and magnetic resonance imaging showed that the course of the nerve root was normal (ie, medial and then inferior, along the pedicle) in 10 patients and was deviated posteriorly in 9 patients. The patients with a normal nerve root course (N-NRC) had either a bony callus projecting medially into the spinal canal (n = 6) or a low mean percentile of vertebral slip (n = 4; 13.9 +/- 1.3). ⋯ The foraminal craniocaudal entrapment and ventrodorsal impingement highly agreed with the side of radicular pain (kappa= 0.73, P < 0.001). Our results demonstrate that the medially projecting bony callus and the percentile of vertebral slip affect the course of the nerve root in the neural foramen, which in turn determines the foraminal craniocaudal entrapment or ventrodorsal impingement. These two mechanisms, based on the course of the nerve root, correlate well with the side of radicular pain.
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J Spinal Disord Tech · Jun 2004
Sacral insufficiency fracture surgically treated by fibular allograft.
Sacral insufficiency fractures have been known to occur distally after long instrumentation to the sacrum. Most such fractures are treated nonoperatively, but surgery is indicated for patients who have nonunions, persistent pain, neurologic deficits, or gross displacement. The current report elucidates the potential complication of sacral fracture after long lumbar arthrodesis, reviews the pertinent literature, presents three patients with sacral fractures after long instrumented lumbar spinal arthrodesis to the sacrum, and describes a new surgical technique for stabilizing such fractures. ⋯ All three patients were followed to radiographic and clinical union. The authors conclude that sacral fracture is a potential complication after a long lumbar arthrodesis. Nonoperative techniques are often successful, but when they are not, a new technique using fibular allografts can be successful.