Journal of neurosurgery. Spine
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The authors report their experience in treating 21 patients by using a novel form of treatment of lumbar degenerative disease that leads to canal stenosis. The surgery involved distraction of the facets using specially designed Goel intraarticular spacers and was aimed at arthrodesis of the spinal segment in a distracted position. The operation is based on the premise that subtle and longstanding facet instability, joint space reduction, and subsequent facet override had a profound and primary influence in the pathogenesis of degenerative lumbar canal stenosis. The surgical technique and the rationale for treatment are discussed. ⋯ Impaction of the spacers within the articular cavity after facet distraction resulted in reversal of several effects of spine degeneration that had caused spinal and root canal stenosis. The safe, firm, and secure stabilization at the fulcrum of lumbar spinal movements provided a ground for segmental spinal arthrodesis. The immediate postoperative and lasting recovery from symptoms suggests the validity of the procedure.
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Comparative Study
Left-right axial rotation within C1-2 after implant removal.
Surgical treatment of atlantoaxial injuries may be performed by a variety of surgical procedures, with each of these having its own specific advantages and disadvantages. To preserve the range of motion within the atlantoaxial joint after surgical treatment, posterior atlantoaxial screw fixation according to the method of Goel and Harms could be beneficial. This technique is not considered to fix the joint permanently if the screws are removed. However, this must not necessarily be true, especially if one notices that cervical joints have a tendency for rapid fusion after surgery. The objective of this study was to analyze left-right axial rotation following implant removal, with the following research questions addressed: 1) is there a relevant rotational left-right mobility in C1-2; 2) is there a difference in mobility depending on sex; 3) is there a correlation of mobility to age; 4) is there a correlation of mobility to the "implant-in-body time"; and 5) is neck pain improved by this method of surgical treatment? ⋯ The authors conclude that removal of the implants 3-6 months after posterior atlantoaxial fixation according to the method of Goel and Harms is beneficial for obtaining some axial rotation within the atlantoaxial joint. The range of motion preserved depends on the age of the patient.
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Historical Article
Little-known Swiss contributions to the description, diagnosis, and surgery of lumbar disc disease before the Mixter and Barr era.
The understanding of lumbar spine pathologies made substantial progress at the turn of the twentieth century. The authors review the original publication of Otto Veraguth in 1929 reporting on the successful resection of a herniated lumbar disc, published exclusively in the German language. His early report is put into the historical context, and its impact on the understanding of pathologies of the intervertebral disc (IVD) is estimated. ⋯ The causal relationship was not confirmed until Mixter and Barr's landmark paper in 1934 describing the association of sciatica and lumbar disc herniation, after which the surgical treatment became increasingly popular. Veraguth was among the first physicians to report on the clinical course of a patient with successful resection of a herniated lumbar disc. His observations should be acknowledged in view of the limited experience and literature on this ailment at that time.