Journal of neurosurgery. Spine
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OBJECTIVE Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). METHODS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. ⋯ CONCLUSIONS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL.
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OBJECTIVE The lateral transpsoas approach to the lumbar spine is a well-defined procedure for the management of discogenic spinal pathology necessitating surgical intervention. Intervertebral device subsidence is a postoperative clinical risk that can lead to recurrence of symptomatic pathology and the need for surgical reintervention. The current study was designed to investigate static versus expandable lateral intervertebral spacers in indirect decompression for preserving vertebral body endplate strength. ⋯ The expandable spacer consistently produced greater desired distraction than was created by the static spacer in the foam-block model (p ≤ 0.05). Distraction created by fully expanding the spacer was significantly greater than the predetermined goals of 2 mm and 3 mm (p ≤ 0.05). CONCLUSIONS The current investigation shows that increased trialing required for a static spacer may lead to additional iatrogenic endplate damage, resulting in less distraction and increased propensity for postoperative implant subsidence secondary to endplate disruption.
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Review Case Reports
Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature.
OBJECTIVE Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%-9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. ⋯ CONCLUSIONS This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease demonstrated on imaging, further study is warranted and underway.
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OBJECTIVE The objective of this study was to determine factors associated with admission to the hospital through the emergency room (ER) for patients with a primary diagnosis of low-back pain (LBP). The authors further evaluated the impact of ER admission and patient characteristics on mortality, discharge disposition, and hospital length of stay. METHODS The authors conducted a retrospective analysis of patients with LBP discharged from hospitals according to the Nationwide Inpatient Sample (NIS) between 1998 and 2007. ⋯ Uninsured and African American patients with LBP were more likely to be admitted through the ER than their counterparts, as were patients with more preexisting health problems. Interestingly, patients with LBP at the highest income levels were more likely to be admitted through hospital ERs. The findings suggest that socioeconomic factors may play a role in the utilization of ER resources by patients with LBP, which in turn appears to impact at least the short-term outcome of these patients.