Spine
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A biomechanical study of human cadaveric sacra using insertional torque and bone mineral density was conducted to determine the optimal sagittal trajectory of S1 pedicle screws. ⋯ The screws directed into the apex of the sacral promontory of the S1 pedicle resulted in an average 99% increase in peak insertional torque (P = 0.005), as compared with bicortical S1 pedicle screw fixation. Tricortical pedicle screw fixation correlates directly with bone mineral density.
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A retrospective review involving 307 consecutive cases of lumbar disc herniation managed by posterolateral endoscopic discectomy was conducted. ⋯ The surgical outcome of posterolateral endoscopic discectomy for lumbar disc herniation is comparable with that for the traditional open transcanal microdiscectomy. Intracanal and extracanal herniations, reherniations, and incidental lateral recess stenosis can be addressed by the same approach.
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Meta Analysis Comparative Study
Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy.
This study involved a search of MEDLINE (1966 to 2000), EMBASE (1980 to 2000), and the Cochrane Controlled Trials Register. The authors of the identified randomized controlled trials were contacted to detect any additional published or unpublished data. The trials selected for this study included all the truly unconfounded or quasi-randomized controlled investigations allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management," or 2) "early decompressive surgery" or "delayed decompressive surgery." Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted the data. ⋯ The data from the reviewed trials were inadequate to provide reliable conclusions on the balance of risk and benefit from cervical spine surgery for spondylotic radiculopathy or myelopathy.
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In a study investigating the correlation between a set of designed criteria and judgments of surgical experience, 100 cervical magnetic resonance images from different patients were used. ⋯ Strong correlations exist between objective measurements and the choice of surgical approach for anterior spine fusion. Among investigated anatomic relations, the instrument manubrial thoracic distance correlated most reliably with the surgeons' choice of the anterior approach. Such objective measurements represent tools that cervical spine surgeons can use to determine the surgical approach.
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Case Reports
Dumbbell-shaped meningioma with cystic degeneration in the thoracic spine: a case report.
A case report of dumbbell-shaped meningioma in the thoracic spine with cystic degeneration for which a combined posterior microscopic and anterior thoracoscopic approach was used is described. ⋯ With combined microscopic and thoracoscopic surgery, dumbbell-shaped meningioma could be completely resected. The thoracoscopic approach for the removal of a paravertebral tumor can be a good alternative to thoracotomy.