Journal of spinal disorders & techniques
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J Spinal Disord Tech · Dec 2007
The use of fuzzy logic to select which curves need to be instrumented and fused in adolescent idiopathic scoliosis: a feasibility study.
Selection of the appropriate curve fusion levels for surgery in adolescent idiopathic scoliosis (AIS) is a complex and difficult task. Despite numerous publications on this subject, the decision as to which spinal curve, that is proximal thoracic, main thoracic or lumbar, needs to be instrumented and included in the fusion relies mostly on each surgeon's past experience, although recently published data have revealed a high variability of spinal instrumentation configurations among spinal surgeons in AIS. This situation exists because of ambiguity and vagueness in the decision process. ⋯ When all input values are entered in the model for a specific subject with AIS, the software calculates the level of suggestion for the indication to perform an instrumentation and fusion of the high thoracic and/or lumbar curves for this particular subject. The usefulness of this approach is demonstrated using illustrative cases. This is the first report on the use of fuzzy logic to assist the decision-making process in the field of spinal deformity surgery and the results suggest that this approach may be useful to facilitate surgical planning in difficult or borderline cases of AIS.
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J Spinal Disord Tech · Dec 2007
Case ReportsIso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of Hangman fracture: a case report.
Direct pedicle screw fixation of the C2 is rarely performed in trauma owing to the risk of damage to the neurovascular structures. Computed tomography-based navigation has the problem of change in intersegmental anatomy after positioning for surgery. Iso-C-based computer navigation acquires the intraoperative real-time images after patient positioning and thus avoids registration errors and improves accuracy. ⋯ To our knowledge, this is the first reported case of displaced Hangman fracture treated successfully using Iso-C fluoroscopic navigation assisted direct pedicle screw osteosynthesis in the literature. Intraoperative acquisition of fluoroscopic images avoids registration-related problems. Three-dimensional fluoroscopic navigation gives excellent accuracy and safety in screw instrumentation of Hangman fracture.
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Anterior cervical discectomy and fusion (ACDF) is a common procedure for radicular and spondylotic disease of the cervical spine. Radiographs are routinely used to evaluate complications in the postoperative ACDF patient, especially airway compromise. Our purpose was to establish baseline data on the amount of change that can be expected in the prevertebral soft tissues after this procedure in the uncomplicated asymptomatic (no airway compromise) 1 or 2-level ACDF patient. Our hypothesis was that the upper cervical spinal levels (C2-C4) would experience greater degrees of swelling than the lower cervical spine (C5-C7). To date no published data exist in the English literature upon which to judge symptomatic patients (experiencing postoperative airway distress) radiographically. ⋯ As we predicted, the greatest edema was noted in the upper cervical spine. Studies need to be performed to compare the radiographic data of symptomatic patients with the baseline data we have collected.
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J Spinal Disord Tech · Oct 2007
Open-door laminoplasty with suture anchor fixation for cervical myelopathy in ossification of the posterior longitudinal ligament.
Expansive laminoplasty was developed to achieve posterior spinal cord decompression while preserving cervical spine stability. In the classic Hirabayashi procedure, the lamina door is tethered open by sutures between the spinous process and facet capsule or paravertebral muscle. The authors present a modified technique, which enhances secure fixation and prevents restenosis owing to hinge closure. ⋯ No neurologic deterioration owing to hinge reclosure or major surgery-related complications were observed. In conclusion, unilateral open-door laminoplasty with suture anchor fixation effectively maintains expansion of the spinal canal and resists closure while preserving alignment and stability. This modified technique has a low complication rate and provides marked functional improvement in patients with cervical myelopathy owing to ossification of the posterior longitudinal ligament.
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J Spinal Disord Tech · Oct 2007
Randomized Controlled Trial Multicenter StudyClinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up.
Prospective, randomized, 3-center, clinical trial. ⋯ At 24 months, cervical arthroplasty with the BRYAN Cervical Disc Prosthesis compares favorably with ACDF as defined by standard outcomes scores.