Journal of neurosurgery. Spine
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Multilevel cervical arthroplasty achieved using the Prestige ST disc can be challenging and often unworkable. An alternative to this system is a hybrid technique composed of alternating total disc replacements (TDRs) and fusions. In the present study, the authors review the safety and radiological outcomes of cervical hybrid arthroplasty in which the Prestige ST disc is used in conjunction with 2 unique fusion techniques. ⋯ Hybrid cervical arthroplasty involving the placement of a Prestige ST disc and either the Mystique resorbable plate or Prevail stand-alone interbody device is a safe and effective alternative to multilevel fusion for the management of cervical radiculopathy and myelopathy.
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Access to the ventral intradural spinal canal may be required for treatment of a variety of lesions affecting the spinal cord and adjacent intradural structures. Adequate exposure is usually achieved through a standard posterior laminectomy or posterolateral approaches, although formal anterior approaches are used to access lesions in the subaxial cervical spine. Modifications of the standard posterior exposure as well as ventral or ventrolateral approaches are increasingly being used for treating intradural spinal pathologies. In this study, the authors review their experience with 35 consecutive cases of ventral intradural spinal lesions. ⋯ Most intradural spinal lesions can be treated with contemporary microsurgical techniques with long-term control or cure of the lesion and preservation of neurological function. Standard posterior approaches provide adequate exposure to safely remove the vast majority of these lesions without the need for a potentially destabilizing resection of the facet or pedicle. Posterior exposures with varying degrees of lateral bone resection, dentate ligament division, and gentle cord rotation may also provide adequate exposure for safe removal of nonmidline ventrolateral superficial pial presenting spinal cord lesions. Nevertheless, in certain cases of ventral intradural lesions, anterior approaches are necessary and should be considered under appropriate circumstances.
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Spinopelvic balance is based on the theory that adjacent segments of the spine are related and influenced by one another. By understanding the correlation between the thoracolumbar spine and the pelvis, a concept of spinopelvic balance can be applied to adult deformity. The purpose of this study was to develop a mathematical relationship between the pelvis and spine and apply it to a population of adults who had undergone spinal deformity surgery to determine whether patients in spinopelvic balance have improved health measures. ⋯ Restoring a normative relationship between the spine and the pelvis during adult deformity correction may play an important role in determining surgical outcomes in these patients independent of sagittal balance.
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Spinal cord injury (SCI) often results in irreversible and permanent neurological deficits below the injury site and is considered a pathological state of functional damage to local neurons and axon fibers. There are several experimental treatments to minimize tissue damage, and recently cell transplantation has emerged as a promising approach in spinal cord repair. The authors undertook this study to evaluate grafting of neural tube precursors as a possible therapeutic strategy in a model of spinal cord compression in the mouse. ⋯ These results support the therapeutic potential of NPs, demonstrating that they can survive for a long time, differentiate, integrate into the injured spinal cord, and promote functional recovery after SCI.
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Comparative Study
A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors.
Standard approaches to thoracic intradural tumors often involve a large incision and significant tissue destruction. Minimally invasive techniques have been applied successfully for a variety of surgical decompression procedures but have been rarely used for the removal of intradural thoracolumbar tumors. In this paper, the authors compare the clinical outcome of mini-open resection of intradural thoracolumbar tumors with a standard open technique. ⋯ The mini-open approach allows for adequate treatment of intradural thoracolumbar tumors with comparable outcomes to standard, open approaches. The mini-open approach is associated with less blood loss and a shorter length of stay compared with standard open surgery.