Journal of spinal disorders & techniques
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J Spinal Disord Tech · Oct 2002
Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty.
A total of 103 patients with cervical spondylotic myelopathy undergoing laminoplasty were retrospectively reviewed to evaluate whether sagittal alignment of the cervical spine and morphology of the spinal cord influence surgical outcomes. Sagittal alignment of the cervical spine did not influence surgical outcomes. ⋯ It is important to acquire anterior convexity of the spinal cord after surgery if laminoplasty is performed below C3. In patients with kyphosis, where anterior convexity of the spinal cord is not thought to be obtained postoperatively, it is possible that additional decompression of C2 improves outcome.
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J Spinal Disord Tech · Aug 2002
Randomized Controlled Trial Clinical TrialLocal application of steroids following lumbar discectomy.
In this prospective randomized clinical study, the effectiveness of epidural steroids to reduce pain following lumbar disc surgery was assessed. Sixty-one patients undergoing lumbar discectomy were included. They were assigned randomly to receive, immediately after removal of the disc, either 80 mg methylprednisolone acetate (Depomedrol) or the same amount (2 mL) of saline. ⋯ Statistically significant back pain relief was observed on postoperative days 1, 2, 6, and 14 in the study group (the group that received steroids). No difference between the two groups was found 1 year after surgery or when leg pain was compared. No side effects that could be related to the steroids were observed.
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J Spinal Disord Tech · Aug 2002
Clinical TrialEpidural injections for the treatment of symptomatic lumbar herniated discs.
Epidural steroid injections are widely used as part of the conservative care for symptomatic herniated lumbar discs. There are studies showing their effectiveness, and some studies demonstrating no clinical benefits. The purpose of this study was to evaluate the effectiveness of epidural steroid injections for patients with symptomatic lumbar disc herniations who were surgical candidates. ⋯ Only 16 (23%) patients failed to have significant relief of their symptoms and required surgical treatment of their herniated disc. Epidural steroid injections have a reasonable success rate for the alleviation of radicular symptoms from lumbar herniated discs for up to twelve to twenty-seven months. Patients treated with injections may be able to avoid surgical treatment up to this period and perhaps even longer.
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J Spinal Disord Tech · Jun 2002
Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations.
Lumbopelvic fixation in spinal and pelvic surgery relies on rods or screws as an iliac anchor. Secure placement of screws with maximum diameter and length for the greatest pullout strength requires knowledge of the iliac structure and of intraoperative fluoroscopic landmarks for secure placement. Therefore, the authors evaluated the intrailiac length, inner width, and cortical thickness of three different transiliac screw anchor paths aimed toward the anterior inferior iliac spine and initiated at the iliac tubercle, posterior superior iliac spine, or posterior inferior iliac spine. ⋯ Two stereotypic iliac constrictions allowed placement of 8-mm implants in male and 6- to 7-mm implants in female patients. Cortical thickness at that optimal extraarticular path was 5.2 mm in the male and 4.7 mm in the female patients. Transiliac screws can be placed during operation under fluoroscopic control using standard lateral and obturator oblique-outlet views, the latter presenting a stereotypical teardrop figure above the acetabulum.
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J Spinal Disord Tech · Jun 2002
Clinical Trial Controlled Clinical TrialDoes provocative discography screening of discogenic back pain improve surgical outcome?
The value of preoperative provocative discography in the setting of discogenic low back pain was investigated by evaluating surgical outcomes. Seventy-three consecutive patients who underwent posterolateral interbody and posterior spinal arthrodesis for discogenic low back pain refractory to nonoperative management were reviewed. Chronologically, the first 41 patients (group A) were indicated without discography, whereas the remaining 32 (group B) had been indicated only if their pain had been reproduced during disc injection. ⋯ Using modified Oswestry scoring, group A and group B patients had satisfactory outcomes of 75.6% and 81.2%, respectively. This difference was neither statistically significant nor suggestive. In this study, provocative discography screening did not improve surgical outcomes after circumferential fusion for lumbar discogenic back pain.