Journal of neurosurgery. Spine
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Historical Article
Thoracolumbar spinal deformity: Part I. A historical passage to 1990: historical vignette.
Seven millennia of anthropological artifacts and historical tales reference human spinal deformity, its diagnosis, and treatment-many of the latter of which turned out to be worse than the deformity itself. From Hippocrates to Harrington to the 21st century, the literature base has expanded in exponential fashion to yield an imperfect but constantly improving body of evidence, experience, and understanding of this challenging disease phenomenon. This review details the pre-1990 innovations, whose failures and successes have equally contributed to the advancement and dissemination of the increasingly evidence-based field of spinal deformity.
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This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc. ⋯ In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.
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The pedicle screw has been reported to provide the strongest fixation for the cervical spine, but there is a possibility of malpositioning the screws, which may cause fatal complications such as vertebral artery and neural injuries. Using the conventional freehand technique, between 6.7 and 29% of the screws have been found to be malpositioned. If an accurate entry point and insertion trajectory through the isthmus of the pedicle can be maintained during surgery, safer insertion of the pedicle screw should be achieved. The authors have developed a new pedicle screw insertion method, called the "CT cutout" technique, and report on the technical and clinical aspects of this new technique in terms of accuracy. ⋯ Several techniques for pedicle screw insertion such as computer-assisted navigation, CT-based navigation, and acquisition of fluoroscopic intraoperative pedicle axis views have been used for improving accuracy. However, there remains a possibility of misplacement, and these costly procedures often require delivery of a high x-ray dose to both patients and surgeons, and/or time-consuming configuration of reference points during surgery. The CT cutout technique is an easy, low-cost procedure that can be performed with the aid of single-plane fluoroscopy and without the need of configuration. This new technique shows great promise for safe pedicle screw insertion for the cervical spine.
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With the introduction of electrophysiological spinal cord monitoring, surgeons have been able to perform radical resection of intramedullary spinal cord tumors (IMSCTs). However, factors associated with tumor resectability, tumor recurrence, and long-term neurological outcome are poorly understood. ⋯ Gross-total resection can be safely achieved in the vast majority of IMSCTs when an intraoperative plane is identified, independent of pathological type. The incidence of acute perioperative neurological decline increases with patient age but will improve to baseline in nearly half of patients within 1 month. Long-term improvement in motor, sensory, and bladder dysfunction may be achieved in a slight majority of patients and occurs more frequently in patients in whom a surgical plane can be identified. A GTR should be attempted for ependymoma and hemangioblastoma, but it may not affect PFS for astrocytoma. For all tumors, the intraoperative finding of a clear tumor plane of resection carries positive prognostic significance across all pathological types.
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Comparative Study
Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression.
The effects of sagittal kyphotic deformities or mechanical stress on the development of cervical spondylotic myelopathy, or the reduction and fusion of kyphotic sagittal alignment have not been consistently documented. The aim in this study was to determine the effects of kyphotic sagittal alignment of the cervical spine in terms of neurological morbidity and outcome after 2 types of surgical intervention. ⋯ Kyphotic deformity and mechanical stress in the cervical spine may play an important role in neurological dysfunction. In a select group of patients with kyphotic deformity > or = 10 degrees , adequate correction of local sagittal alignment may help to maximize the chance of neurological improvement.