Journal of neurosurgery. Spine
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The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. ⋯ Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.
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Comparative Study
Pedicle screw insertion angle and pullout strength: comparison of 2 proposed strategies.
Minimally invasive pedicle screws inserted vertically (that is, dorsoventrally) through the pedicle, as opposed to the more common coaxial technique, offer potential advantages by minimizing soft-tissue stripping during screw placement. The screws are designed for insertion through a medial starting point with vertical trajectory through the pedicle and into the vertebral body. As such, no lateral dissection beyond the insertion point is necessary. However, the effects of this insertion technique on the screw biomechanical performance over a short- and long-term are unknown. The authors investigated the pullout strength and stiffness of these screws, with or without fatigue cycling, compared with comparably sized, traditional screws placed by coaxial technique. ⋯ The use of Group B screws inserted through a medial starting point showed greater pullout load than a Group A screw inserted through a standard starting point. The greater pullout strength in Group B screws may be due to screw thread design and increased cortical bone purchase at the medial starting point. Nevertheless, anatomical considerations of the medial starting point, that is, pedicle or lateral vertebral body cortex breach, may limit its application. The medial starting point of the Group B screw was frequently in the facet at the L-3 and L-4 pedicle entry points, which may have clinical importance.
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Review
Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review.
Coccygodynia is disabling pain in the coccyx and is usually provoked by sitting or rising from sitting. The diagnosis can be missed by neurosurgeons likely to encounter the disorder, and surgical treatment for coccygodynia has historically been viewed with caution. The authors conducted a retrospective review of 62 successive coccygectomy surgeries for coccygodynia performed at their institution. ⋯ The authors report the results of their clinical case series, which to date is the largest in North America. The results closely concur with previously published case series from Europe. Coccygectomy for chronic intractable coccygodynia is simple and effective, with a low complication rate. A comprehensive literature review and discussion of coccygectomy is provided.
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Multicenter Study
Outcomes after incidental durotomy during first-time lumbar discectomy.
Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is, however, controversial. The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome. ⋯ Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients.