Journal of neurosurgery. Spine
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OBJECT The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. METHODS Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5-15 degrees (kyphosis correction), and spinal fusion was performed in all cases. ⋯ CONCLUSIONS A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.
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OBJECT The purpose of this retrospective study was to quantify the anatomical relationship between the vertebral artery (VA), the cervical pedicle, and its surrounding structures, including the incidence of irregularities. Additionally, data delineating a "safe zone," and these data's application during instrumentation with transpedicular cervical screw fixation were considered. The anatomical proximity of the VA to the cervical pedicle prevents spine surgeons from preferring cervical pedicle screws (CPSs) over lateral mass screws at levels C3-6. ⋯ Pedicle diameter, safe zone, and occupational ratio of the VA in the foramen determine the risk associated with instrumentation and should be assessed individually. Based on the authors' measurements, C-4 and C-7 can be considered critical levels for CPS placement. Because of this and the high incidence of irregular VA pathways and different entry points, it may be helpful to review neck CT angiography studies before considering posterior instrumentation procedures in the cervical spine.
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OBJECT The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. METHODS Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. ⋯ CONCLUSIONS During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.
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Both posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) have been frequently undertaken for lumbar arthrodesis. These procedures use different approaches and cage designs, each of which could affect spine stability, even after the addition of posterior pedicle screw fixation. The objectives of this biomechanical study were to compare PLIF and TLIF, each accompanied by bilateral pedicle screw fixation, with regard to the stability of the fused and adjacent segments. ⋯ Regarding stability, PLIF provides a higher immediate stability compared with that of TLIF, especially in lateral bending. Based on our findings, however, PLIF and TLIF, each with posterolateral fusions, have similar biomechanical properties regarding ROM, IDP, and laminar strain at the adjacent segments.
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Case Reports
Utility of neurophysiological monitoring using dorsal column mapping in intramedullary spinal cord surgery.
Intramedullary spinal cord tumors can displace the surrounding neural tissue, causing enlargement and distortion of the normal cord anatomy. Resection requires a midline myelotomy to avoid injury to the posterior columns. Locating the midline for myelotomy is often difficult because of the distorted anatomy. Standard anatomical landmarks may be misleading in patients with intramedullary spinal cord tumors due to cord rotation, edema, neovascularization, or local scar formation. Misplacement of the myelotomy places the posterior columns at risk of significant postoperative disability. The authors describe a technique for mapping the dorsal column to accurately locate the midline. ⋯ Dorsal column mapping is a useful technique for guiding the surgeon in locating the midline for myelotomy in intramedullary spinal cord surgery. In conjunction with somatosensory evoked potential, motor evoked potential, and D-wave recordings, we have been able to reduce the surgical morbidity related to dorsal column dysfunction in this small group of patients.