European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
-
Previous experimental studies have shown the effects of acute compression of the spinal cord and peripheral nerve roots. Recently, however, a few studies of chronic compression of the cauda equina in animal models have been reported. The purpose of this study was to determine the long-term electrophysiologic changes resulting from chronic compression of the cauda equina in dogs. ⋯ Dogs in which motor and sensory evoked potentials recovered also showed gradual disappearance of neurologic symptoms and signs. Recovery of motor evoked potentials in particular was associated with complete disappearance of neurologic symptoms and signs. For accurate prognosis in cases of chronic cauda equina compression, a combined diagnostic study of sensory and motor evoked potentials is recommended.
-
Failed back surgery syndrome (FBSS) is the presence of persistent, disabling pain in the hip, thigh, leg, or lower back of a patient who has undergone a laminectomy or discectomy. Some degree of FBSS is found in approximately 15% of such patients. There may be a direct relationship between the extent of pathology found during the initial surgical procedure and the probability that FBSS will develop. ⋯ In an attempt to inhibit peridural fibrosis, methylprednisolone, polyethylene films, and fat grafts have been applied to the dura after discectomy. These experimental treatments have had limited success. Development of a therapy that reliably prevents peridural adhesive fibrosis will reduce the incidence of FBSS.
-
Comparative Study
Correction of idiopathic scoliosis using the H-frame system.
To determine the effectiveness of posterior H-frame instrumentation for the surgical treatment of idiopathic scoliosis, 36 patients were studied. The patients underwent surgery between 1989 and 1993 and were evaluated for curve correction, hump correction, vertebral rotation, fusion level and complications. Average age at surgery was 19 years. ⋯ Major neurological problems did not occur. Pseudoarthrosis developed in one patient and imbalance in two patients. The H-frame system satisfactorily achieves curve and rib hump correction with little correction loss.
-
Case Reports
Suction/irrigation for deep wound infection after spinal instrumentation: a case study.
Deep wound infection after spinal instrumentation is a serious complication that is difficult to treat without removing the instruments and bone graft. Debridement and suction/irrigation is an effective method of treatment in these cases. ⋯ Four patients with early post-operative infection were cured by this method without removing the instruments and bone graft, and two patients with delayed post-operative infection were cured by this method with instrument removal. Debridement and suction/irrigation is a useful method of treatment for both groups of deep wound infection and gives good results when performed soon after infection onset together with additional antibiotic therapy.
-
The segmental effect of Cotrel-Dubousset instrumentation (CDI) on the spine and thoracic cage was investigated in 38 patients with adolescent idiopathic scoliosis by preoperative and postoperative postero-anterior and lateral radiographs and computed tomography from T1 to S1. Mean Cobb angle decreased by 67%. The T5-T12 kyphosis in the hypokyphotic patients increased on average by 8.4 degrees (P < 0.001). ⋯ However, no correlation was found between flexibility index and reduction of RHi at the apex level. Vertebral derotation did not correlate with reduction in RHi at any level. The study shows that CDI results in a postoperative three-dimensional improvement of the spine and a limited improvement of the thoracic cage, with no tendency towards a worsened deformity at any level within or outside the instrumentation.