Journal of neurosurgery. Spine
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As the population continues to age, relatively older geriatric patients will present more frequently with complex spinal deformities that may require surgical intervention. To the authors' knowledge, no study has analyzed factors predictive of complications after major spinal deformity surgery in the very elderly (75 years and older). The authors' objective was to determine the rate of minor and major complications and predictive factors in patients 75 years of age and older who underwent major spinal deformity surgery requiring a minimum 5-level arthrodesis procedure. ⋯ Patients 75 years and older undergoing major spinal deformity surgery have an overall perioperative complication rate of 62%, with older age increasing the likelihood of a complication, and a long-term postoperative complication rate of 52%. Patients in this age group with a history of hypertension are 10 times more likely to incur a major perioperative complication. However, the mortality risk for these patients is not increased.
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Thoracolumbar fracture-dislocations are devastating injuries. They usually require surgical reduction and stabilization. The authors present a novel technique for reducing these injuries that is predictable and reproducible.
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Few studies have evaluated the prognostic significance of different types of T2-weighted MR imaging changes in patients with cervical spondylotic myelopathy (CSM). The object of this study was to determine whether the type of increased signal intensity (ISI) was an independent predictor of outcome following central corpectomy in patients with CSM or ossification of the posterior longitudinal ligament (OPLL). ⋯ Increased signal intensity on preoperative T2-weighted MR images was seen in more than 80% of the cases. However, only Type 2 ISI on T2-weighted images had a prognostic significance of being associated with a decreased likelihood of cure in patients with CSM or OPLL. Hypointensity on T1-weighted images predicted a lower probability of cure among patients with Type 2 ISI on T2-weighted images.
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Controlled Clinical Trial
Analysis of ascending spinal tract degeneration in cervical spondylotic myelopathy using 3D anisotropy contrast single-shot echo planar imaging on a 3.0-T system.
The authors assessed the role of 3D anisotropy contrast (3DAC) in evaluating specific ascending tract degeneration in patients with cervical spondylotic myelopathy (CSM). ⋯ The study unambiguously demonstrated that 3DAC imaging is capable of assessing ascending tract degeneration in patients with CSM. Degeneration of an individual tract can be easily identified as a vector contrast change on the 3DAC image, a reflection of quantitative changes in anisotropism, similar to fractional anisotropy. Excellent correlation between Nurick grades and fasciculus gracilis degeneration suggests potential application of 3DAC imaging for tract-by-tract clinical correlation.
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Implanted intrathecal drug delivery systems may malfunction as a result of fracture of the intrathecal catheter. A suspected catheter fracture not seen on plain radiographs of the catheter system will typically prompt a contrast-enhanced imaging study of the pump. Injection of iodinated contrast medium into the pump system with routine fluoroscopy can sometimes fail to reveal subtle leaks. ⋯ The leak was visible on source images and was especially obvious after 3D reconstruction. This led to surgical revision of the catheter and subsequent resumption of normal pump function. The authors therefore suggest that if a leak is suspected in an implanted intrathecal catheter and routine contrast fluoroscopy is unrevealing, post-injection 3D-CT scanning should be performed to further investigate the possibility of a subtle leak.