Journal of neurosurgery. Spine
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Cervical kyphosis in patients with ankylosing spondylitis (AS) can be severely disabling. Surgical treatment of this disorder is technically demanding, however, with a considerable risk of neurological and vascular injuries. The extension osteotomy is a well-described posterior treatment for this condition, but this approach presents the risk of acute subluxation and spinal column translation during the reduction. ⋯ Controlled correction was performed by using a hinged rod affixed to posterior cervical and thoracic screws, allowing for free sagittal correction while restricting translational forces. Once the desired angle of correction was achieved, the hinge connector was locked, transforming the rod into a rigid device for permanent internal fixation. The use of hinged rods in cervical kyphosis correction provides a controlled method for reduction at the osteotomy site, decreasing the risk of neurological injury.
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Case Reports
A novel anterior technique for simultaneous single-stage anterior and posterior cervical release for fixed kyphosis.
The incidence rate of kyphosis of the cervical spine after a laminectomy can be as high as 20% after a multilevel laminectomy. The loss of the posterior tension band leads to increased load on the vertebral body and discs, leading to further degenerative changes and kyphotic deformities. The initial decompression of the spinal cord disappears as the cord is stretched over the anterior lesions. ⋯ The lateral mass and facets can then be accessed anteriorly using an osteotome or drill for the release. The authors illustrate this technique in a patient who developed fixed scoliosis and kyphosis of the cervical spine after surgery for degenerative disc disease. To the authors' knowledge, this is the first report of this technique.
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Comparative Study
Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage.
An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. ⋯ Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.
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Comparative Study
Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection.
The indications remain unclear for fusion at the time of cervical laminectomy for intradural tumor resection. To identify patients who may benefit from initial fusion, the authors assessed clinical, radiological/imaging, and operative factors associated with subsequent symptomatic cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. ⋯ In the authors' experience with intradural cervical tumor resection, patients presenting with myelopathic motor symptoms or those undergoing a >or= 3-level cervical laminectomy had an increased likelihood of developing subsequent symptomatic instability requiring fusion. A >or= 3-level laminectomy with myelopathic motor symptoms may herald patients most likely to benefit from cervical fusion at the time of tumor resection.
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Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. ⋯ Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.