Journal of neurosurgery. Spine
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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.
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Comparative Study
Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion.
Cervical stenotic myelopathy due to spondylosis or ossification of the posterior longitudinal ligament is often treated with laminoplasty or cervical laminectomy (with fusion). The goal of this study was to compare outcomes, radiographic results, complications, and implant costs associated with these 2 treatments. ⋯ Patients treated with laminoplasty and patients treated with laminectomy and fusion had similar improvements in Nurick scores, mJOA scores, and Odom outcomes. Patients who underwent fusion typically had higher preoperative neck pain scores, but their neck pain improved significantly after surgery. There was no significant change in the neck pain scores of patients treated with laminoplasty. Our series suggests cervical fusion significantly reduces neck pain in patients with stenotic myelopathy, but that the cost of the implant and rate of reoperation are greater than in laminoplasty.
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Central neuropathic pain is a frequent challenging complication after spinal cord injury (SCI), and specific therapeutic approaches remain elusive. The purpose of the present investigations was to identify potential key mediators of these pain syndromes by analyzing detailed expression profiles of important chemokines in an experimental SCI paradigm of posttraumatic neuropathic pain in rats. ⋯ The authors report lesion grade-dependent upregulation of different chemokines/chemokine receptors after spinal cord contusion lesions in pain-processing spinal cord regions in a clinically relevant model of traumatic SCI in rats. Prolonged chemokine induction further correlated with below-level pain development in the delayed time course after severe SCI and was coexpressed with pain-associated peptides and receptors, suggesting that chemokines play a crucial role in chronic central pain mechanisms after SCI.
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The Goel technique, in which C1-2 intraarticular spacers are used, may be performed to restore stability to a disrupted atlantoaxial complex in conjunction with the Harms technique of placing polyaxial screws and bilateral rods. However, it has yet to be determined biomechanically whether the addition of the C1-2 joint spacers increases the multiaxial rigidity of the fixation construct. The goal of this study was to quantify changes in multiaxial rigidity of the combined Goel-Harms technique with the addition of C1-2 intraarticular spacers. ⋯ Study result indicated that both the Goel and Harms techniques alone and with the addition of the C1-2 intraarticular spacers to the Goel-Harms technique are advantageous for stabilizing the atlantoaxial segment. The Goel technique combined with placement of a screw/rod construct appears to result in additional construct rigidity beyond the screw/rod technique and appears to be more useful in very unstable cases.