Spine
-
Comparative Study
Differential biomechanical effects of injury and wiring at C1-C2.
An in vitro study compared the biomechanics of the upper cervical spine among three groups of cadaveric specimens, each with a different source of instability: transverse-alar-apical ligament disruptions, odontoid fractures, or odontoidectomies. The responses of the three groups were again compared after a uniform posterior cable and graft fixation was applied to the specimens. ⋯ The three different injuries produce different spinal biomechanical responses. To best promote fusion, posterior cable and graft fixation should be used with an adjunctive stabilizing technique to treat all three injuries.
-
This is a retrospective review of all patients requiring either Cotrel-Dubousset or Moss Miami rod removal. All initial spinal instrumentations were for adolescent idiopathic scoliosis from 1985 through 1994. Twenty-two patients who underwent rod removal for late-developing infection constitute the study group. ⋯ Late-appearing infection with spinal instrumentation can be treated with device removal, primary skin closure, and short-term oral antibiotics. The infections affect soft tissue, not the bone.
-
A case report of os odontoideum with retro-odontoid soft tissue hypertrophy treated by the transarticular screw fixation. ⋯ Posterior atlantoaxial fixation is worth trying in slow progressing myelopathy by the compression of hypertrophy of the soft tissue even in nonrheumatoid atlantoaxial subluxation, thereby obviating the need for direct removal of the mass via the transoral route.
-
The risk factors for complications and complication and survival rates in patients with metastatic disease of the spine were reviewed. A retrospective study was performed. ⋯ The likelihood that a complication occurred was significantly related to Harrington classifications demonstrating significant neurologic deficits and the use of preoperative radiation therapy. In general, Harrington classifications with neurologic deficits and lower Frankel grades before and after surgery were associated with an increased risk of complication. Overall, the major complication rate was relatively low, and minor complications were successfully treated with minimal morbidity. The relatively long survival time after spinal surgery in this group of patients justifies surgical treatment for metastatic disease. Most complications occurred in a small percentage of patients. To minimize complications, patients must be carefully selected based on expected length of survival, the use of radiation therapy, presence of neurologic deficit, and impending spinal instability or collapse caused by bone destruction.
-
Meta Analysis
The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis.
A Cochrane review of randomized controlled trials. ⋯ There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management. The Cochrane reviews will be updated continuously as other trials become available.