Journal of neurosurgery. Spine
-
Randomized Controlled Trial Comparative Study
Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article.
The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes. There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis (LSS), but there are currently no studies comparing outcomes with matched controls. The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression (ULBD) to a standard "open" laminectomy for LSS. ⋯ Based on short-term follow-up, microscopic ULBD is as effective as open decompression in improving function (ODI score), with the additional benefits of a significantly greater decrease in pain (VAS score), postoperative recovery time, time to mobilization, and opioid use.
-
Accurate insertion of C-2 cervical screws is imperative; however, the procedures for C-2 screw insertion are technically demanding and challenging, especially in cases of C-2 vertebral abnormality. The purpose of this study is to report the effectiveness of the tailor-made screw guide template (SGT) system for placement of C-2 screws, including in cases with abnormalities. ⋯ This study demonstrates that the SGT system provided extremely accurate C-2 cervical screw insertion without configuration of reference points, high-dose radiation from intraoperative 3D navigation, or any registration or probing error evoked by changes in spinal alignment during surgery. A multistep screw placement technique and reliable screw guide cylinders were the key to accurate screw placement using the SGT system.
-
Cervical laminoplasty is a surgical procedure for cervical compressive myelopathy (CCM), and satisfactory outcomes have been reported. However, few reports have examined the pathophysiology of improvements in spinal cord function. The aim of this study was to investigate the variation in central motor conduction time (CMCT) before and after cervical laminoplasty in patients with CCM. ⋯ These results suggest that cervical laminoplasty improves corticospinal tract function 1 year after surgery, which may be one of the reasons for the JOA score improvements in patients with CCM. The degree of improvement in corticospinal tract function did not correlate with patient age in this case series. The results demonstrated quantitative evidence of the pathophysiology of functional recovery in the corticospinal tract following cervical laminoplasty in patients with CCM.
-
Increased sagittal vertical axis (SVA) correlates strongly with pain and disability for adults with spinal deformity. A subset of patients with sagittal spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flatback deformity and normal SVA. The authors' objective was to compare baseline disability and treatment outcomes for patients with compensated (SVA < 5 cm and PI-LL mismatch > 10°) and decompensated (SVA > 5 cm) SSM. ⋯ Decompensated SSM patients with elevated SVA experience significant disability; however, the amount of disability in compensated SSM patients with flatback deformity caused by PI-LL mismatch but normal SVA is underappreciated. Surgical correction of SSM demonstrated similar radiographic and HRQOL score improvements for patients in both groups. Evaluation of SSM should extend beyond measuring SVA. Among patients with concordant pain and disability, PI-LL mismatch must be evaluated for SSM patients and can be considered a primary indication for surgery.
-
A cortical bone trajectory (CBT) is a new pedicle screw trajectory that maximizes the thread contact with cortical bone surface, providing enhanced screw purchase. Despite the increased use of the CBT in the lumbar spine, little is known about the insertion technique for the sacral CBT. The aim of this study was to introduce a novel sacral pedicle screw trajectory. This trajectory engages with denser bone maximally by the screw penetrating the S-1 superior endplate through a more medial entry point than the traditional technique, and also has safety advantages, with the protrusion of the screw tip into the intervertebral disc space carrying no risk of neurovascular injury. ⋯ The penetrating S-1 endplate technique through the medial entry point is suitable for the connection of lumbar CBT, has revealed favorable stability for lumbosacral fixation, and has reduced the potential risk of neurovascular injuries.