Journal of neurosurgery. Spine
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Laminoplasty is the preferred operation for most patients with cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL). Recent studies have demonstrated several significant risk factors for poor clinical outcomes after laminoplasty, including older age, lower preoperative Japanese Orthopaedic Association (JOA) score, postoperative change in cervical alignment, cervical kyphosis, and high occupying ratio of the OPLL (that is, the ratio of the greatest anteroposterior thickness of the OPLL to the anteroposterior diameter of the spinal canal at the same level on a lateral image). However, the impact of dynamic factors on clinical outcomes is unclear. The purpose of this study is to assess the impact of dynamic factors on the clinical outcome after laminoplasty for cervical myelopathy due to OPLL. ⋯ Fusion surgery may be a useful strategy in patients with preoperative hypermobility of the cervical spine.
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Clinical Trial
Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery.
The aim of this study was to provide evidence for the effect of intrathecal morphine application after spinal cord tumor resection. ⋯ Intrathecal morphine for postoperative analgesia after resection of cervical and thoracic spinal cord tumors is effective and safe. These preliminary results require confirmation by larger comparative studies and further clinical experience.
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Extradural en plaque meningiomas are very rare tumors in the spinal canal. Most studies on these lesions have been case reports with literature reviews. In this paper, the authors review their experience in a surgical series of 12 patients with histologically proven, purely extradural en plaque meningiomas and discuss their clinical features, radiological findings, and long-term outcomes. ⋯ Spinal extradural en plaque meningiomas are amenable to surgery if complete removal can be achieved. Because of the encirclement of the dura that is characteristic of the tumors, complete resection is usually difficult, subtotal removal for spinal cord decompression is advised, and follow-up imaging is needed. The risk of long-term recurrence/regrowth of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected.
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Case Reports
Solid radiographic fusion with a nonconstrained device 5 years after cervical arthroplasty.
Cervical disc arthroplasty (CDA) has been gaining popularity as a surgical alternative to anterior cervical discectomy and fusion. Spontaneous fusion following a CDA is uncommon. A few anecdotal reports of heterotrophic ossification around the implant sites have been noted for the BRYAN, ProDisc-C, Mobi-C, PRESTIGE, and PCM devices. ⋯ He was pain free, with a VAS score of 0, NDI score of 0, and SF-36 PCS and MCS scores of 61 and 55, respectively. Conclusions This is the first case report that identifies the phenomenon of fusion around a nonconstrained cervical prosthesis. Despite this unwanted radiographic outcome, the patient's clinical outcome was excellent.
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Despite limited availability and the morbidity associated with autologous iliac crest bone graft (ICBG), its use in anterior lumbar interbody fusion (ALIF) procedures remains the gold standard to achieve arthrodesis. The search for alternative grafts yielding comparable or superior fusion outcomes with fewer complications continues. In particular, i-FACTOR, a novel bone graft substitute composed of anorganic bone matrix (ABM) with P-15 small peptide, is one example currently used widely in the dental community. Although preclinical studies have documented its usefulness, the role of i-FACTOR in ALIF procedures remains unknown. The authors' goal was to determine the safety and efficacy of i-FACTOR bone graft composite used in patients who underwent ALIF by evaluating fusion rates and clinical outcomes. ⋯ The use of i-FACTOR bone graft substitute demonstrates promising results for facilitating successful fusion and improving clinical outcomes in patients who undergo ALIF surgery for degenerative spinal pathologies.