Journal of neurosurgery. Spine
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Randomized Controlled Trial Multicenter Study
Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site.
The authors report on a prospective randomized controlled multicenter trial in which they compared the clinical outcomes obtained in patients who underwent the placement of a Bryan Cervical Disc System with those obtained in patients who underwent anterior cervical discectomy and fusion (ACDF). In the present study, they evaluated the safety and effectiveness of the artificial disc based on data obtained at a single investigational site. ⋯ The preliminary results documented at this investigational site are encouraging. Evaluation of data acquired in the Bryan disc treatment group showed that improvements in the clinical parameters were similar to those in the fusion group. Additionally in the artificial disc-treated group, there was radiographic evidence that motion was maintained. It is theorized that motion preservation may potentially reduce the rate of adjacent-level cervical disc disease that has been documented in patients who undergo ACDF.
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Clinical Trial
Quality of life assessment in patients undergoing nucleoplasty-based percutaneous discectomy.
Nucleoplasty is a minimally invasive surgical procedure for disc decompression developed to treat patients with symptomatic contained herniated discs. Nucleoplasty uses nonheat-driven radiofrequency energy to ablate and coagulate the disc nucleus via a percutaneous "discography" trajectory under fluoroscopic guidance. In this study the authors evaluated pain, functioning, and quality of life (QOL) in patients with radicular leg and back pain who underwent nucleoplasty-based percutaneous disc decompression. ⋯ Nucleoplasty-based percutaneous disc decompression in patients with symptomatic contained disc herniations is safe and improves QOL as measured by the SF-36, EQ5D, and VAS for pain, three generic QOL outcome instruments. Nucleoplasty is an effective minimally invasive surgical treatment alternative in patients with symptomatic contained disc hemiations. Further follow-up evaluation is underway to determine the durability of QOL improvement after nucleoplasty.
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Case Reports
Recurrent sciatica due to periligamentous trapped epidural gas after spinal sequestrectomy.
The authors describe the unusual case of a 50-year-old woman who suffered from sciatic pain due to periligamentous trapped epidural gas after lumbar sequestrectomy. The patient underwent removal of free herniated disc material via a translaminar approach through the L-5 lamina without discectomy. ⋯ After evacuation of the gas, her pain resolved. Postoperative intraspinal gas may be symptomatic in the rare case.
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Clinical Trial
Computerized tomography-guided kryorhizotomy in 76 patients with lumbar facet joint syndrome.
The authors prospectively evaluated the therapeutic effect of computerized tomography (CT)-guided kryorhizotomy in the treatment of patients with lumbar facet joint syndrome (LFJS) and assessed prognostic factors that predict this effect. ⋯ Computerized tomography-guided kryorhizotomy is a minimally invasive and repeatable treatment that yields good long-term results in patients with LFJS.
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Clinical Trial
Safety of transforaminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein-2.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is being increasingly used for spinal fusion. There are few data regarding its clinical safety, effectiveness, and clinical outcome when applied on an absorbable collagen sponge (ACS) in conjunction with allograft for transforaminal lumbar interbody fusion (TLIF). ⋯ Analysis of the results demonstrated that TLIF combined with a BMP-2-soaked ACS is a feasible, effective, and safe method to promote lumbar fusion. There were no significant intergroup differences in clinical outcome between patients who underwent open compared with minimally invasive procedures. Patient satisfaction rates, however, were higher in the minimally invasive procedure group. The efficacy of BMP-2 was not dependent on which approach was used or the number of spinal levels that were treated.