Journal of neurosurgery
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Journal of neurosurgery · Jul 2001
Comparative StudyCadaveric fibula, locking plate, and allogeneic bone matrix for anterior cervical fusions after cervical discectomy for radiculopathy or myelopathy.
The authors have previously reported that the results of using cadaveric fibula and locking plate (CF/LP) fusion following anterior cervical discectomy (ACD) for cervical spondylotic radiculopathy and myelopathy are superior to those obtained using autologous iliac crest (AIC) grafts in the short term. The long-term results of using this construct are important in substantiating this improvement. The authors report on 246 consecutive patients (54% smokers) who underwent ACD with CF/LP fusion (175 with allogeneic bone matrix [ABM]) and compare them with 111 consecutive patients in whom AIC fusions (49% smokers) were performed by the same surgeons. ⋯ When fusion is necessary following ACD, the results of CF/LP fusion are significantly superior in the first 5 years after surgery compared with those for AIC fusions. It remains to be determined if demineralized ABM has a significant effect in enhancing fusion.
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Journal of neurosurgery · Jul 2001
Comparative StudyAdjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion.
Of concern to spine surgeons are accelerated degenerative changes of motion segments located above and below where spinal fusion has been performed. Graf artificial ligament stabilization has been developed to avoid the adverse effect of spinal fusion. The object of this study was to assess the adjacent-segment morbidity of Graf ligamentoplasty compared with posterolateral fusion (PF) in which instrumentation was used. ⋯ Graf ligamentoplasty cannot completely replace spinal fusion. In a well-selected group of patients, however, it was shown to maintain lumbar mobility and sagittal alignment, and it decreased the risk of adjacent-segment deterioration compared with PF with instrumentation.
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Journal of neurosurgery · Jul 2001
Threaded cortical bone dowels for lumbar interbody fusion: over 1-year mean follow up in 28 patients.
The authors retrospectively reviewed a series of 35 patients with mechanical low-back or one- to two-level discogenic pain; the patients underwent lumbar interbody fusion in which threaded cortical bone dowels (TCBDs) were placed to treat degenerative disc disease. The purpose of the study was to delineate fusion rates and outcome data in this series of patients. ⋯ Analysis of the mean 12.3 month follow-up data indicates that there is a dramatically higher fusion rate in PLIF compared with ALIF procedures when TCBDs are used. The authors believe that it is important to note that in all the PLIF procedures except one, supplemental pedicle screw/rod constructs were used, whereas in ALIF procedures no supplemental fixation was performed. The results thus suggest that TCBDs are best used in PLIF in conjunction with pedicle screw and rod constructs.
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Journal of neurosurgery · Jul 2001
Case ReportsHematogenous pyogenic facet joint infection of the subaxial cervical spine. A report of two cases and review of the literature.
Two cases of hematogenous, pyogenic, subaxial cervical facet joint infection are reported, and the literature is reviewed. Infection of the cervical facet joint is a rarely diagnosed condition; only one case has been reported in the literature. Lumbar facet joint infections are also rare but more commonly reported. ⋯ Hematogenous cervical facet joint infection is a rare clinical entity that has many characteristics in common with the more-common lumbar homolog. All three reported cases, however, have been complicated by epidural abscess or granulation tissue formation that has led to a neurological deficit. This finding suggests that a facet joint infection in the cervical spine may have a less benign clinical course than that in the lumbar spine.
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The authors describe a simple, new method for removing broken pedicle screws. Under microscopic visualization a straight, narrow slot is etched in the broken surface of the pedicle screw by using a power drill with a 2-mm diamond burr. A minus screwdriver is then inserted into the slot, and the broken screw is rotated and removed. ⋯ This method allows preservation of both the pedicle and the screw hole. Consequently, it is possible to insert new pedicle screws into the same hole without losing the strength and stability of pedicle screw fixation. The authors recommend this simple and new method for removal of broken pedicle screws.