Journal of spinal disorders & techniques
-
J Spinal Disord Tech · Apr 2007
Management of deep wound infection after posterior lumbar interbody fusion with cages.
To evaluate long-term treatment outcome of patients with infected posterior lumbar interbody fusion (PLIF) managed with surgical debridement and or prolonged antiobiotic treatment without removal of the interbody cages. ⋯ In cases of postoperative deep wound infection after PLIF with cages, removal of the interbody implants is not necessary. Treatment is composed of prolonged antibiotic therapy guided by antimicrobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.
-
J Spinal Disord Tech · Feb 2007
A novel source of cancellous autograft for ACDF surgery: the manubrium.
There are a variety of techniques and biologic options when performing interbody fusion during an anterior cervical discectomy and fusion (ACDF). Autologous graft provides high rates of fusion; however, complications associated with donor site morbidity from the iliac crest have prompted some surgeons to use alternative graft material. Ten patients (8 men, 2 women) with cervical radiculopathy underwent single-level ACDF with plate fixation, titanium mesh cage, and cancellous autograft from the manubrium. ⋯ No complications associated with the manubrium donor site were noted; however, 1 female patient was dissatisfied with its cosmetic appearance. The manubrium is an effective, safe, and technically facile source of autologous bone graft that yields high fusion rates and patient satisfaction in contemporary ACDF surgery. This new technique to obtain cancellous graft from the manubrium combines the advantages of autologous bone without the morbidity of iliac crest harvest.
-
J Spinal Disord Tech · Feb 2007
Case Reports Comparative StudyAn analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty.
We compared the surgical outcome of anterior decompression with spinal fusion (ASF) with the surgical outcome of laminoplasty for patients with cervical myelopathy due to ossification of the posterior longitudinal ligament. ⋯ These results demonstrated that the surgical outcome of ASF was superior to the surgical outcome of laminoplasty. Elderly patients treated with laminoplasty showed an especially poor surgical outcome. We suggest that hypermobility of vertebrae at the cord compression level is a risk factor for poor surgical outcome after laminoplasty. Based on these results, we recommend that ASF should be the first choice of treatment for patients with significant ossification of the posterior longitudinal ligament and a hypermobile cervical spine. When laminoplasty is used for such cases, the addition of posterior instrumented fusion would be desirable for stabilizing the spine and decreasing damage to the spinal cord.
-
J Spinal Disord Tech · Feb 2007
Comparative StudyIs one cage enough in posterior lumbar interbody fusion: a comparison of unilateral single cage interbody fusion to bilateral cages.
Posterior lumbar interbody fusion (PLIF), as recommended with bilateral lumbar interbody cages and pedicle screw fixation, has increased the successful fusion rate to nearly 100%. Presently, a unilateral approach to the disc space with a variant of PLIF, the trans-foraminal interbody fusion is often used. There are few clinical studies of unilateral interbody fusion. ⋯ Fusion was successful at all single cage fusion levels and overall in 23/26 (88%) reviewing all levels of fusion. In conclusion, fusion and clinical success rates were not diminished by the use of a unilateral interbody cage rather than the recommended 2 cages. This retrospective comparative study is a Level III-2 Therapeutic Study investigating the results of unilateral PLIF with a single interbody cage compared with historical series with interbody cages.
-
J Spinal Disord Tech · Feb 2007
Minimally invasive 2-level posterior cervical foraminotomy: preliminary clinical results.
The management of cervical radiculopathy has undergone significant evolution, and the most recent advancement is the integration of minimally invasive surgical techniques. There have been relatively few reports in the medical literature describing the clinical results of minimally invasive cervical spine surgery. The authors describe the surgical indications, technique, and preliminary clinical outcomes in a series of patients who underwent the 2-level minimally invasive posterior cervical foraminotomy procedure. ⋯ Minimally invasive 2-level posterior cervical foraminotomy can be safely performed on an outpatient basis with results comparable to that of conventional foraminotomy. This procedure should be considered as a potential alternative to 2-level anterior cervical discectomy and fusion or open foraminotomy in selected patients.