Journal of neurosurgery. Spine
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The aim in this study was to determine whether granulocyte-macrophage colony-stimulating factor (GM-CSF) leads to sensory improvement in rat spinal cord injury (SCI) models. ⋯ Treatment with GM-CSF results in functional recovery, improving tactile and cold sense recovery in a rat SCI model. Granulocyte-macrophage colony-stimulating factor also minimizes abnormal sprouting of sensory nerves after SCI.
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Randomized Controlled Trial Multicenter Study Comparative Study
Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease.
The purpose of this study was to evaluate the long-term safety and effectiveness of the ProDisc-L total disc replacement (TDR) as part of an FDA-mandated postmarket approval study. This report summarizes the clinical findings after 5 years of follow-up. ⋯ Patients in both groups maintained significant improvement during the 5-year follow-up. The TDR group had significantly better improvement on some scales. Although TDR patients avoid the stiffness of fusion and are more satisfied than fusion patients, both fusion and TDR are reasonable surgical options in this specific patient population.
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Randomized Controlled Trial Multicenter Study Comparative Study
Five-year adjacent-level degenerative changes in patients with single-level disease treated using lumbar total disc replacement with ProDisc-L versus circumferential fusion.
The authors report the 5-year results for radiographically demonstrated adjacent-level degenerative changes from a prospective multicenter study in which patients were randomized to either total disc replacement (TDR) or circumferential fusion for single-level lumbar degenerative disc disease (DDD). ⋯ At 5 years after the index surgery, ProDisc-L maintained ROM and was associated with a significantly lower rate of ΔALDs than in the patients treated with circumferential fusion. In fact, the fusion patients were greater than 3 times more likely to experience ΔALDs than were the TDR patients. Clinical trial registration no.: NCT00295009.
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Traditional procedures for correction of sagittal imbalance via shortening of the posterior column include the Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. These procedures require wide exposure of the spinal column posteriorly, and may be associated with significant morbidity. Anterior longitudinal ligament (ALL) release using the minimally invasive lateral retroperitoneal approach with a resultant net lengthening of the anterior column has been performed as an alternative to increase lordosis. The objective of this study was to demonstrate the feasibility and early clinical experience of ALL release through a minimally invasive lateral retroperitoneal transpsoas approach, as well as to describe its surgical anatomy in the lumbar spine. ⋯ This initial experience suggests that ALL release through the minimally invasive lateral retroperitoneal transpsoas approach may be feasible, allows for improvement of lumbar lordosis without the need of an open laparotomy/thoracotomy, and minimizes the tissue disruption and morbidity associated with posterior osteotomies.
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Case Reports
Dorsal myelopathy secondary to epidural fibrous scar tissue around a spinal cord stimulation electrode.
The authors describe a patient with delayed thoracic spinal cord compression due to fibrous scar tissue around an epidural electrode used in spinal cord stimulation (SCS). One year after implantation of the system the stimulation became ineffective, and 1 year later the patient developed progressive paraparesis. There was no evidence of device-related complications on plain radiographs and CT scans, so the system was removed to perform MRI studies. ⋯ The histological examination confirmed fibrosis, and microbiological studies excluded chronic infection. As far as the authors are aware, this complication has never been reported before at the thoracic level. Scarring around SCS electrodes should be considered as a late complication and as a possible cause of the tolerance phenomenon.