Journal of neurosurgery. Spine
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Case Reports
Cervical myelopathy in patients with ossification of the posterior longitudinal ligament.
The authors assessed the clinical course in patients with a narrowed cervical spinal canal caused by ossification of the posterior longitudinal ligament (OPLL), but who have no or only mild myelopathy. Additionally, the authors analyzed the factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. ⋯ In the present study, the authors demonstrate that the mobility of the cervical spine and the type of OPLL are important factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. The authors advocate conservative treatment in most patients with OPLLs who have no or only mild myelopathy, even in the presence of spinal canal narrowing.
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Spine fractures are a significant cause of morbidity and mortality after motor vehicle crashes (MVCs). Public health interventions, such as the National Highway Traffic Safety Administration's Federal Motor Vehicle Safety Standards, have led to an increase in automobiles with air bags and the increased use of seat belts to lessen injuries sustained from MVCs. The purpose of this study was to evaluate secular trends in the occurrence of spine fractures associated with MVCs and evaluate the association between air bag and seat belt use with spine fractures. ⋯ Among drivers and front-seat passengers admitted to the hospital after MVCs, the occurrence of spine fractures increased from 1994 to 2002 despite concomitant increases in seat belt and air bag use. However, the occurrence of severe spine fractures did not increase over the study period. The use of both seat belt and air bag is protective against spine fractures. Although the overall increased occurrence of spine fractures may appear contrary to the increased use of seat belts and air bags in general, it is possible that improved imaging technology may be associated with an increase in the diagnosis of relatively minor fractures. However, given the significant protective effects of both seat belt and air bag use against spine fractures, resources should continue to be dedicated toward increasing their use to mitigate the effects of MVCs.
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The purpose of this study was to evaluate complications and radiographic and functional outcomes of isolated anterior stabilization surgery in which structural allograft and plates were used for posterior unstable subaxial cervical spine lateral mass, facet, and ligamentous injuries. ⋯ Anterior cervical discectomy and fusion performed using interbody structural allograft and plate fixation is highly effective in the treatment of unstable posterior cervical lateral mass, facet, and ligamentous injuries. This treatment option results in low intraoperative blood loss, short operating times, and a brief LOS. Radiographic outcomes with respect to segmental stability are excellent, and fusion rates with the use of structural allograft alone are high. Outcomes with respect to pain, function, and patient satisfaction are high, and complications are acceptably low.
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Hyperbaric oxygen therapy (HBO) is used as primary and/or adjunctive therapy in the treatment of various clinical conditions complicated by local hypoxia. It may have therapeutic potential in the treatment of neurosurgical infections such as spinal osteomyelitis that are associated with significant morbidity rates. The purpose of this study was to evaluate the efficacy of HBO therapy in the treatment of spinal osteomyelitis. ⋯ Hyperbaric oxygen therapy enabled infection cure in 5 of 6 patients with spinal osteomyelitis complicated by medical comorbidities or the failure of primary therapy. These results show that HBO may be a useful adjunctive therapeutic modality in the treatment of spinal osteomyelitis, particularly when there are medical comorbidities that increase the risk of poor healing. Hyperbaric oxygen therapy may also be beneficial in patients with relapsing primary spinal osteomyelitis after standard therapy has failed.
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The goal of this study was to analyze the placement accuracy and complications of thoracolumbar pedicle screws (PSs) inserted using 3D image guidance in a large patient cohort. ⋯ Three-dimensional image guidance is a useful adjunct to placement of spinal instrumentation. The complication rate in this study was low, and accurate placement of instrumentation was achieved despite the high percentage of revision surgery cases in our patient population. Additionally, because active fluoroscopy was not used for instrumentation placement, there was minimal to no radiation exposure to the surgeon or operating room staff.