Journal of neurosurgery. Spine
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OBJECT Pseudarthrosis and adjacent-segment degeneration remain problems after fusion surgery. To overcome these complications, many dynamic stabilization methods have been developed. This study was conducted to elucidate the midterm results on the effectiveness of interspinous ligamentoplasty (ILP) to treat degenerative spondylolisthesis. ⋯ CONCLUSIONS Interspinous ligamentoplasty is a good option treating patients with Grade 1 degenerative spondylolisthesis requiring surgery. It is less invasive and effectively stabilizes the unstable spine with a relatively small incidence of postoperative instability. Interspinous ligamentoplasty provides satisfactory clinical and radiological results at midterm follow-up.
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OBJECT The aim in this prospective study was to determine the morphological limitations of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL) by using intraoperative ultrasonography and to investigate correlations between ultrasonographic findings and 2-year follow-up results. METHODS Included in this study were 40 patients who underwent double-door laminoplasty for cervical myelopathy due to OPLL. Intraoperative ultrasonography was used to evaluate posterior shift of the spinal cord after the posterior decompression procedure. ⋯ The C2-7 angle had no impact on ultrasonographic findings. CONCLUSIONS Laminoplasty has a morphological limitation for thick OPLLs, and a thickness > 7.2 mm represents a theoretical cutoff for residual cord compression after laminoplasty. According to 2-year results, however, laminoplasty can remain the first choice for any type of multiple-level OPLL.
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OBJECT Numerous techniques have been historically used for occipitocervical fusion with varied results. The purpose of this study was to examine outcomes of various surgical techniques used in patients with various disease states to elucidate the most efficacious method of stabilization of the occipitocervical junction. METHODS A literature search of peer-reviewed articles was performed using PubMed and CINAHL/Ovid. ⋯ For patients requiring occipitocervical arthrodesis for the treatment of inflammatory diseases, screw/rod constructs are associated with the most favorable outcomes, while posterior wiring and onlay in situ bone grafting is associated with the least favorable outcomes. Occipitocervical arthrodesis performed for the diagnosis of tumor is associated with the lowest rate of successful arthrodesis using screw/rod techniques, while posterior wiring and rods have the highest rate of arthrodesis. The nonspecified disease group had the lowest rate of surgical adverse events and the highest rate of neurological improvement.
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OBJECT Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. ⋯ Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP. CONCLUSIONS Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis.
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OBJECT The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. METHODS Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5-15 degrees (kyphosis correction), and spinal fusion was performed in all cases. ⋯ CONCLUSIONS A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.