Journal of spinal disorders & techniques
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J Spinal Disord Tech · Jul 2007
Failure of the Wallis interspinous implant to lower the incidence of recurrent lumbar disc herniations in patients undergoing primary disc excision.
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. ⋯ 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.
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Since the Food and Drug Administration approved the Babgy-Kuslich BAK cage for anterior lumbar interbody fusion (ALIF), various threaded interbody fusion devices have been introduced. Bone dowels offer several theoretical advantages over cages with regard to stress shielding; the purpose of this study was to assess the efficacy of bone dowels in interbody fusion. All patients undergoing ALIF performed by the senior author between 1998 and 2001 were retrospectively reviewed. ⋯ There were no clinical failures in patients treated with supplemental anterior or posterior spinal fixation. These data demonstrate that marginal fusion rates and functional success rates can be achieved using stand-alone bone dowels for ALIF. The clinical success and fusion rates are significantly higher if ALIF dowels are shielded from stress with rigid spinal instrumentation.
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J Spinal Disord Tech · Jul 2007
Screw pull-out force is dependent on screw orientation in an anterior cervical plate construct.
Two common justifications for orienting cervical screws in an angled direction is to increase pull-out strength and to allow use of longer screws. This concept is widely taught and has guided implant design. Fixed versus variable angle systems may offer strength advantages. ⋯ When all 4 screws are 90 degrees to the plate the construct has the greatest ability to resist pullout. Fixed angle designs show no advantage over variable angle. These findings are contrary to current teaching.
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J Spinal Disord Tech · Jul 2007
The frequency and etiology of intraoperative dural tears in 110 predominantly geriatric patients undergoing multilevel laminectomy with noninstrumented fusions.
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. ⋯ 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).
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J Spinal Disord Tech · Jul 2007
Case ReportsUsing intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine: a case report.
This report describes the clinical usefulness of using intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine. ⋯ Intraoperative, continuous free-running electromyography proved clinically effective in determining the course of surgery.