Journal of neurosurgery. Spine
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OBJECTIVE Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. A variety of techniques have been used clinically to improve pedicle screw fixation in the presence of compromised bone. Pedicle screws may be augmented with cement, but this may lead to cement leakage and result in disastrous consequences. ⋯ The mean ODI score improved from 83.7% before surgery to 29.7% after the operation and to 36.1% at the final follow-up. No screw migration had occurred at the 1-year follow-up, but 1 screw breakage/migration was visualized on spinal radiography at the 2-year follow-up. CONCLUSIONS The results of this study show that the multiaxial expandable pedicle screw is a safe and practical technique for patients with osteoporosis and various spinal diseases and adds a valuable tool to the armamentarium of spinal instrumentation.
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OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. ⋯ EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.
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OBJECTIVE The relief of leg symptoms by surgical decompression for lumbar stenosis is well supported by the literature. Less is known about the effect on back pain. Some surgeons believe that the relief of back pain should not be an expected outcome of decompression and that substantial back pain may be a contraindication to decompression only; therefore, stabilization may be recommended for patients with substantial preoperative back pain even in the absence of well-accepted indications for stabilization such as spondylolisthesis, scoliosis, or sagittal malalignment. ⋯ The vast majority of discharges (88%) were routine home discharges. At 3 and 12 months postoperatively, there were significant improvements from baseline for back pain (7.62 to 3.19 to 3.66), leg pain (7.23 to 2.85 to 3.07), EQ-5D (0.55 to 0.76 to 0.75), and ODI (49.11 to 27.20 to 26.38). CONCLUSIONS Through the 1st postoperative year, patients with lumbar stenosis-without spondylolisthesis, scoliosis, or sagittal malalignment-and clinically significant back pain improved after decompression-only surgery.
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Multicenter Study Clinical Trial
Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome.
OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. ⋯ A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 ( clinicaltrials.gov ).
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CT-based morphometric analysis of the occipital condyle: focus on occipital condyle screw insertion.
OBJECTIVE The segmental occipital condyle screw (OCS) is an alternative fixation technique in occipitocervical fusion. A thorough morphological study of the occipital condyle (OC) is critical for OCS placement. The authors set out to introduce a more precise CT-based method for morphometric analysis of the OC as it pertains to the placement of the segmental OCS, and they describe a novel preoperative simulation method for screw placement. ⋯ CONCLUSIONS The placement of the segmental OCS is feasible in most cases, but a thorough preoperative radiological analysis is essential and cannot be understated. The height available for the OCS is a more clinically relevant and precise parameter than the height of the OC to enable proper screw placement. The warning depth may be helpful for the placement of the OCS.