Journal of neurosurgery. Spine
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In sacroiliac screw fixation of unstable pelvic injuries in geriatric patients, poor bone quality often obscures important bony landmarks in fluoroscopic images. The authors analyzed the feasibility of injecting a transhiatal contrast agent (CA) into the sacral canal to improve fluoroscopic visualization in the sacral epidural space. ⋯ Injection of a transhiatal epidural CA improves fluoroscopic imaging of the sacral canal and of the neural foramina. Hence, this technique could be applied to help the surgeon identify anatomical landmarks during sacroiliac screw fixation in geriatric patients.
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The authors investigated quality of life (QOL) outcomes after primary versus revision discectomy. ⋯ QOL, pain and disability, and psychosocial outcomes improved after primary and revision discectomy, but the improvement diminished after revision discectomy.
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Cortical trajectory screw constructs, developed as an alternative to pedicle screw fixation for the lumbar spine, have similar in vitro biomechanics. The possibility of one screw path having the ability to rescue the other in a revision scenario holds promise but has not been evaluated. The objective in this study was to investigate the biomechanical properties of traditional pedicle screws and cortical trajectory screws when each was used to rescue the other in the setting of revision. ⋯ Cortical trajectory screws, previously studied as a primary mode of fixation, may also be used as a rescue option in the setting of a failed or compromised pedicle screw construct in the lumbar spine. Likewise, a standard pedicle screw construct may rescue a compromised cortical screw track. Cortical and pedicle screws each retain adequate construct stiffness and pullout strength when used for revision at the same level.
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Understanding that atlantoaxial instability is the cause of Chiari malformation (CM), the author treated 65 patients using atlantoaxial stabilization. The results are analyzed. ⋯ On the basis of outcomes in this study, it appears that the pathogenesis of CM with or without associated basilar invagination and/or syringomyelia is primarily related to atlantoaxial instability. The data suggest that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and segmental arthrodesis. Except in cases in which there is assimilation of the atlas, inclusion of the occipital bone is neither indicated nor provides optimum stability. Foramen magnum decompression is not necessary and may be counter-effective in the long run.