Journal of neurosurgery. Spine
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Although there is agreement that low-intensity signal changes on T1-weighted magnetic resonance (MR) images are a prognostic factor for poor outcome after surgical treatment of cervical myelopathy due to chronic cord compression, the role of high-intensity signal changes on T2-weighted images is still controversial. The aim of the present study was to determine whether T2-weighted MR imaging can help assess the prognosis of the disease. ⋯ Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.
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Randomized Controlled Trial Multicenter Study Comparative Study
Quality of life of lumbar stenosis-treated patients in whom the X STOP interspinous device was implanted.
This study was conducted to compare the quality of life (QOL) in patients with neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS). Using the 36-Item Short Form (SF-36) questionnaire, the authors compared the results obtained in patients treated with the X STOP Interspinous Process Decompression (IPD) System with those obtained in patients who underwent nonoperative therapies. ⋯ The results of this study demonstrate that the X STOP device is significantly more effective than nonoperative therapy in improving the QOL in patients with LSS. The results are comparable with those reported in other studies involving traditional decompressive techniques for LSS and suggest that the X STOP implant can provide an effective treatment compared with nonoperative and conventional surgical therapies.
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Comparative Study
Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion.
Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs). The authors compared the clinical and radiographic outcomes of patients who underwent TLIF with pedicle screw fixation, in whom either a PEEK cage or an FCA was placed as an interbody spacer. ⋯ Both PEEK cages and FCAs are highly effective in promoting interbody fusion, maintaining postoperative disc space height, and achieving desirable clinical outcomes in patients who undergo TLIF with pedicle screw fixation. The advantages of PEEK cages include a lower incidence of subsidence and their radiolucency, which permits easier visualization of bone growth.
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The retroperitoneal surgical approach has gained acceptance as a way to access the ventral aspect of the lumbar spine. Visualization is often limited, however, by the psoas muscle, which lies along the posterolateral aspect of the spine. Improved visualization is often attempted by retracting the muscle from the wound, which generally pulls the muscle laterally from the spine but not posteriorly, which is desirable for a better exposure of the spine, particularly the neural elements. In this paper, the authors describe a simple, atraumatic technique for retraction of the psoas muscle that allows excellent visualization of the spine.
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The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors' knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. ⋯ The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient's recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient's recovery.