Journal of spinal disorders & techniques
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J Spinal Disord Tech · Jul 2006
Comparative StudySingle-stage treatment of pyogenic spinal infection with titanium mesh cages.
Single institution retrospective review. ⋯ Titanium mesh cages present a viable option for single-stage anterior surgical debridement and reconstruction of vertebral osteomyelitis, without evidence of chronic infection or rejection. When used in conjunction with pedicle screw instrumentation, there is minimal cage settling without loss of sagittal alignment.
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J Spinal Disord Tech · Jul 2006
Comparative StudyPostoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging.
Many investigators have reported that persistent low back pain may occur after posterior surgical intervention, and studies have investigated the histologic and histochemical changes in back muscle after posterior lumbar spine surgery. The purpose of the current study is to compare the pre- and postoperative cross-sectional area of the back musculature among 5 surgical groups including anterior lumbar interbody fusion, which has no direct invasion of the back musculature, using magnetic resonance imaging, and to correlate the clinical results with the degree of atrophy. The cross-sectional area of the back musculature was measured before and after surgery in T2-weighted axial magnetic resonance images using a computer-linked digitizer. ⋯ Back musculature atrophy occurred even in anterior lumbar interbody fusion, which does not involve any direct surgery of the back muscle. A positive correlation was noted between the atrophy ratio and operation time only in posterior surgery, especially in nonfusion surgery. In conclusion, the current study suggests that a shorter operation time may minimize back muscle injury, and shows that factors inducing back musculature atrophy include not only direct invasion of the back muscle via a posterior approach, but also postoperative external fixation.
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J Spinal Disord Tech · Jul 2006
Comparative StudyThe effect of lumbar total disc replacement on the spinopelvic alignment and range of motion of the lumbar spine.
A lumbar total disc replacement (TDR) is a type of motion-preserving surgery, which aims to restore and maintain the normal range of motion (ROM) and the sagittal balance of the spine. However, little is known regarding how the spinopelvic alignment and ROM of the lumbar spine are influenced by the lumbar TDR with ProDisc. This study retrospectively analyzed the sagittal alignment and ROM of the lumbar spine in 26 consecutive patients who had undergone the TDR with ProDisc with a minimum follow-up of 24 months. ⋯ In the patients who underwent single-level TDR, the mean segmental lordosis at the L5-S1 and L4-5 operative levels increased significantly from 15.8 degrees to 23.2 degrees and from 14.1 degrees to 24.9 degrees, respectively. The mean ROM at L5-S1 and L4-5 increased significantly from 7.1 degrees to 11.2 degrees and from 11.4 degrees to 14.6 degrees, respectively. The sagittal balance and ROM of the lumbar spine improved significantly after the lumbar TDR.
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J Spinal Disord Tech · Jul 2006
Comparative StudyA comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study.
Dysphagia is a well-recognized complication after anterior cervical discectomy and fusion, observed in as high as 50% of cases by videofluoroscopic evaluation postoperatively. Esophageal injury due to surgical retraction is a complication due to which swallowing difficulties may ensue. There are limited published data evaluating the effect of soft tissue retraction on intraesophageal pressures during anterior cervical instrumentation procedures. ⋯ On the basis of the data presented here, anterior cervical plating results in significantly greater intraesophageal pressures when performed at C5-6 compared to C3-4. This holds regardless of whether the plate spans the distance from C3 to C6 (3-level plate) or the single C5-6 level. In addition, the insertion of the cervical disc replacement seems to require less esophageal retraction and hence reduced intraesophageal pressures when compared to anterior cervical plating.
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J Spinal Disord Tech · Jul 2006
Comparative StudyInvestigation of motor dominant C5 paralysis after laminoplasty from the results of evoked spinal cord responses.
Postoperative motor dominant C5 paralysis was known as one of several complications after laminoplasty. Several theories have been proposed for postoperative segmental paralysis after laminoplasty, but its etiology remains unclear. ⋯ Cervical myelopathy at the C4-5 level is a potential risk for motor dominant C5 paralysis. Although it is merely a speculation, when C5 radiculopathy occurs after laminoplasty, C5 paralysis becomes clinically apparent because the deltoid muscle gets predominantly innervated by C5 root due to intramedullary spinal cord damage on the C6 segment in C4-5 myelopathy before surgery. It may represent the high signal intensity area on T2-weighted MRI at the C4-5 level.