Journal of spinal disorders & techniques
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J Spinal Disord Tech · Dec 2006
Comparative StudyBiomechanical comparison of a novel percutaneous transfacet device and a traditional posterior system for single level fusion.
Posterior spinal fusions are indicated for a variety of spinal disorders. Transfacet fixation minimizes soft tissue disruption and preserves the adjacent facet joint. This technique is uncommon due to concerns with biomechanical stability and proper implant placement. ⋯ Percutaneous transfacet fixation is an attractive surgical option for single-level spinal fusions. A biomechanical evaluation of a novel device for this application demonstrated similar stability to a pedicle screw system. The length adjustability of the device may alleviate concerns for precise device placement and the biomechanical stability may produce similar rates and quality of posterior spinal fusions.
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J Spinal Disord Tech · Dec 2006
Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series.
We compare the surgical results of single-stage posterior surgical procedure performed at a single institute with those of anterior procedure, and propose single-stage posterior surgical approach, laminectomy and posterior decompression with transpedicular instrumentation as an alternative operative method for thoracic and thoracolumbar spinal tuberculosis. ⋯ The posterior decompression with transpedicular instrumentation can be an alternative treatment method of less-involved spinal tuberculosis especially for patients in early phase of bone destruction or ones with mild kyphosis.
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J Spinal Disord Tech · Dec 2006
The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases.
Long periods of immobilization, progressive kyphosis and graft failure are the major postoperative problems encountered after anterior radical surgical treatment for tuberculosis of the spine. Posterior fusion and instrumentation can be an effective solution for these problems. Effectiveness of posterior fusion and instrumentation was investigated in this study on the basis of the cases with anterior procedure only, and with combined anterior-posterior procedures. ⋯ No such increase or graft failure was noted in cases of combined anterior-posterior procedure. The difference in terms of kyphosis was found to be statistically significant (P=0.047). Anterior radical debridement and strut graft is the golden standard in the surgical treatment of spinal tuberculosis, but it should always be accompanied by posterior instrumentation and fusion to shorten the immobilization period and hospital stay, obtain good and long lasting correction of kyphosis, and prevent further collapse and graft failure.
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J Spinal Disord Tech · Dec 2006
Comparative StudyStepwise methodology for plain radiographic assessment of pedicle screw placement: a comparison with computed tomography.
The objective of this study is to evaluate the effectiveness of a specific methodology for plain radiographic assessment of lumbar pedicle screw position. ⋯ CT scans, often considered the "gold standard" for clinical assessment of pedicle screw placement, have limitations when validated with gross anatomical dissection. The described systematic method for evaluating pedicle screw placement using orthogonal plain radiographs attained accuracy comparable to high-resolution CT scans.
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J Spinal Disord Tech · Dec 2006
Case ReportsDelayed epidural hematoma after spinal surgery: a report of 4 cases.
Symptomatic postoperative epidural hematoma is a rare and potentially devastating complication of spinal surgery. The overwhelming majority of reported cases have occurred in the immediate postoperative period. A recent publication defined the clinical entity of delayed postoperative epidural spinal hematoma as neurologic deterioration due to an epidural hematoma occurring at least 3 days after the index procedure. ⋯ The 4 patients presented are unusual in their delayed symptomatic presentations of postoperative spinal epidural hematoma. Despite the longer time to onset, however, our patients exhibited many of the characteristics common to cases that presented in the acute postoperative period. The spine surgeon must remain vigilant for the possibility of postoperative spinal epidural hematoma in at-risk patients, even weeks after the original surgical procedure.