Journal of neurosurgery. Spine
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Comparative Study
Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?
For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population. ⋯ Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.
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Ankylosing spondylitis (AS) is a genetic condition that frequently results in spinal sagittal plane deformity of thoracolumbar or cervicothoracic junctions. Generally, a combination of osteotomy and spinal fixation is used to treat severe cases. Although surgical techniques for traumatic injury across the cervicothoracic junction have been well characterized in clinical and biomechanical literature, the specific model of instrumented opening wedge osteotomy in autofused AS has not been studied biomechanically. This study characterizes the structural stability of various posterior fixation techniques across the cervicothoracic junction in spines with AS, specifically considering the effects of posterior rod diameter and material type. ⋯ The results of this study suggest that 3.5-mm CoCr rods are optimal for achieving the most rigid construct in opening wedge osteotomy in the cervicothoracic region of an AS model. Rod diameter and material properties should be considered in construct strategy. Some surgeons have advocated anterior plating in patients with AS after osteotomy for additional stability and bone graft surface. Although this effect was not examined in this study, additional posterior stability achieved with CoCr may decrease the need for additional anterior procedures.