Journal of spinal disorders & techniques
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J Spinal Disord Tech · May 2007
Changes in disc height and posteroanterior displacement after fusion in patients with idiopathic scoliosis: a 9-year follow-up study.
In scoliosis patients treated with long segment spinal fusion, degenerative changes like retrolisthesis and disc space narrowing below fusion have been observed. However, there is disagreement concerning their incidence and dependency on the location of the lowest instrumented vertebra. ⋯ Long segment spinal fusion in young patients with idiopathic scoliosis did not lead to disc space narrowing during 9.2 years follow-up. However, the observed increase in retrolisthesis potentially indicates the initiation of a degenerative process. These only minimal changes might be referred to the preservation of a physiologic lumbar lordosis. Without correction for vertebral tilt disc space narrowing is overestimated.
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J Spinal Disord Tech · May 2007
Comparative StudyA comparative biomechanical analysis of spinal instability and instrumentation of the cervicothoracic junction: an in vitro human cadaveric model.
Stabilization of the cervicothoracic junction is challenging but commonly required in patients with traumatic, neoplastic, congenital, and postlaminectomy conditions. Although extensive research has been performed on stabilization of the cervical spine, there remains a paucity of published data on instrumentation at the cervicothoracic junction. Using 2-column, 3-column, and corpectomy instability models, a biomechanical analysis was performed on the effects of increasing the number of posterior segmental fixation points and/or anterior column reconstruction at the cervicothoracic junction. ⋯ With 3-column instability posterior segmental fixation alone from C5-T3 was inadequate, and the addition of anterior instrumentation restored flexibility to the intact condition. There was a strong trend toward reduced flexibility with increasing levels of thoracic fixation in all instability models.
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J Spinal Disord Tech · May 2007
Case ReportsTraumatic subdural hematoma of the thoraco-lumbar junction of spinal cord.
Spinal subdural hematoma (SSDH) is an exceedingly uncommon and potentially neurologically devastating condition. Recognition of blood products in magnetic resonance imaging is a very important clue for the diagnosis of SSDH. It is generally agreed that prompt surgical evacuation should be performed before irreversible damage to the spinal cord occurs. However, conservative treatment still plays a role in the management of SSDH. ⋯ Rapid surgical drainage of traumatic SSDH affecting the thoraco-lumbar junction of the cord will be associated in most of the cases with rapid neurologic recovery.
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J Spinal Disord Tech · May 2007
Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis.
Although the transpedicular decancellation osteotomy is a salvage technique for reconstruction of complex spinal deformities, it is not a procedure used exclusively for patients with kyphosis occurring as a sequel of treated tuberculosis. In this study, 16 adult patients with kyphosis underwent transpedicular decancellation osteotomy between 1993 and 1999. Pain, kyphosis angle, sagittal balance, and functional and neurologic status were the main parameters used for the clinical and radiologic assessment. ⋯ The transpedicular decancellation osteotomy effectively corrected the sagittal balance and improved pain and functional status. It was a safe and reliable technique in the treatment of posttuberculosis kyphosis.
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J Spinal Disord Tech · Apr 2007
Clinical TrialA minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study.
Among all lumbar disc herniations, L5-S1 far-lateral disc herniations are rare entities. Besides, surgical approach may be difficult because of the very narrow passage at this level. For these 2 reasons, most spine surgeons are not experienced in herniations at this level. According to new microanatomic studies, previous lateral approaches at this level often do not allow access to the neuroforamen without partial or total destruction of the L5-S1 facet joint. To preserve the facet joint, an approach was developed. ⋯ The authors describe a MIIMA for excising herniated discs that is applicable to all types of far-lateral lumbar herniations. Postoperative dysesthesia is the most important complication and may persist as it did in our cases. Consequently, manipulation of the ganglion should be avoided at all costs, if possible. The MIIMA procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone herniated discs in selected cases. This approach is effective, allowing the preservation of the L5-S1 facet joint, saving the facet joint, preventing postoperative instability, and offering a direct view of the L5-S1 neuroforamen.