Journal of neurosurgery. Spine
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Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a well established procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. ⋯ Transforaminal lumbar interbody fusion with either unilateral or bilateral segmental pedicular instrumentation is an effective treatment for lumbar spondylosis. Because patients with unilateral constructs were 7 times more likely to experience pseudarthrosis and require reoperation, TLIF with bilateral constructs might be the biomechanically superior technique.
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Increased neurotrophin activity in degenerative intervertebral discs (IVDs) is one potential cause of chronic low-back pain (LBP). The aim of the study was to assess if nerve growth factor (NGF) might alter gene expression of IVD cells and contribute to disc degeneration by enhancing expression or activity of factors that cause breakdown of IVD matrix. ⋯ Nerve growth factor has potential effects on matrix turnover activity and influences the catabolic/anabolic balance of IVD cells in an adverse way that may potentiate IVD degeneration. Anti-NGF treatment might be beneficial to ameliorate progressive tissue breakdown in IVD degeneration and may lead to pain relief.
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Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. ⋯ A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.
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Venous thromboembolism (VTE) represents a significant complication after spine surgery, with reported rates as high as 2%-4%. Published institutional practices for VTE prophylaxis are highly variable. In 2008, the authors implemented a departmental protocol for early VTE prophylaxis consisting of combined compressive devices and subcutaneous heparin initiated either preoperatively or on the same day of surgery. In this study, the authors compared the incidence of VTE in spine surgery patients before and after implementing this protocol. ⋯ At a high-volume tertiary center, an aggressive protocol for early VTE prophylaxis after spine surgery decreases VTE incidence without increasing morbidity.
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Spinal stenosis with degenerative lumbar scoliosis (DLS) mostly occurs in the elderly population (typically > 65 years old), causing pain in the legs and back, claudication, and spinal deformity. The surgical strategy for DLS is controversial concerning the surgical approach, fusion area, decompression area, correction methods, and ideal angle of curve correction. A nonfusion stabilization system with motion preservation has been recently used for degenerative spinal diseases with favorable outcomes. This study attempted to analyze surgical outcomes after decompression and nonfusion stabilization for spinal stenosis with a mild to moderate degree of DLS. ⋯ Adding nonfusion stabilization after decompressive surgery resulted in a safe and effective procedure for elderly patients with lumbar stenosis with a mild to moderate scoliosis angle (< 30°). Statistically significant improvement of the clinical outcome was obtained at the last follow-up evaluation with no progression of the degenerative scoliosis.