Journal of neurosurgery. Spine
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Multicenter Study
Multivariate analysis of C-5 palsy incidence after cervical posterior fusion with instrumentation.
Postoperative C-5 palsy is a significant complication resulting from cervical decompression procedures. Moreover, when cervical degenerative diseases are treated with a combination of decompression and posterior instrumented fusion, patients are at increased risk for C-5 palsy. However, the clinical and radiological features of this condition remain unclear. Therefore, the purpose of this study was to clarify the risk factors for developing postoperative C-5 palsy. ⋯ Patients with preoperative foraminal stenosis, posterior shift of the spinal cord, and additional iatrogenic foraminal stenosis due to cervical alignment correction were more likely to develop postoperative C-5 palsy after posterior instrumentation with fusion. Prophylactic foraminotomy at C4-5 might be useful when preoperative foraminal stenosis is present on CT. Furthermore, it might be useful for treating postoperative C-5 palsy. To prevent excessive posterior shift of the spinal cord, the authors recommend that appropriate kyphosis reduction should be considered carefully.
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Comparative Study
Does prior short-segment surgery for adult scoliosis impact perioperative complication rates and clinical outcome among patients undergoing scoliosis correction?
In many adults with scoliosis, symptoms can be principally referable to focal pathology and can be addressed with short-segment procedures, such as decompression with or without fusion. A number of patients subsequently require more extensive scoliosis correction. However, there is a paucity of data on the impact of prior short-segment surgeries on the outcome of subsequent major scoliosis correction, which could be useful in preoperative counseling and surgical decision making. The authors' objective was to assess whether prior focal decompression or short-segment fusion of a limited portion of a larger spinal deformity impacts surgical parameters and clinical outcomes in patients who subsequently require more extensive scoliosis correction surgery. ⋯ Patients with adult scoliosis and a history of short-segment spine surgery who later undergo more extensive scoliosis correction do not appear to have significantly different complication rates or clinical improvements as compared with patients who have not had prior short-segment surgical procedures. These findings should serve as a basis for future prospective study.
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Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5-S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.
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This study was conducted to determine whether postoperative changes in the fractional anisotropy (FA) value and diffusion tensor imaging of the cervical spinal cord can predict functional outcome for patients with cervical compressive myelopathy (CCM). ⋯ The preoperative FT ratio correlated significantly with the recovery rates in CCM patients. Preoperative diffusion tensor tractography can be a new prognostic predictor for neurological recovery in CCM patients after laminoplasty.
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In this paper the authors sought to determine the segmental lumbar sagittal contour change after bilateral transforaminal lumbar interbody fusion (TLIF). ⋯ A significant improvement in lumbar lordosis can be gained by preforming bilateral facetectomies in TLIF with posterior compression. This procedure provides an additional option to a spine surgeon's armamentarium in dealing with significant lumbar sagittal plane deformities.