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
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Comparative Study
The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine.
Transpedicular screw fixation has recently been shown to be successful in stabilizing the middle and lower cervical spine. Controversy exists, however, over its efficacy, due to the smaller size of cervical pedicles and the proximity of significant neurovascular structures to both lateral and medial cortical walls. To aid the spinal surgeon in the insertion of pedicle screws, a number of studies have been performed to quantify the gross dimensions and angulations of the cervical pedicle. ⋯ The pedicle slices were found to exhibit substantial variability in composition and shape, not only between individual spines and vertebral levels, but also within the pedicle axis. However, the lateral cortex was consistently found to be thinner than the medial cortex in all samples. These physical findings must be noted by surgeons attempting transpedicular screw fixation in the cervical spine.
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Interbody cages in the lumbar spine have met with mixed success in clinical studies. This has led many investigators to supplement cages with posterior instrumentation. The objective of this literature review is to address the mechanics of interbody cage fixation in the lumbar spine with respect to three-dimensional stabilization and the strength of the cage-vertebra interface. ⋯ The axial compressive strength of this interface is highly dependent upon vertebral body bone density. Other factors such as preservation of the subchondral bony end-plate and cage design are clearly less important in the compressive strength. Supplementary posterior instrumentation does not enhance substantially the interface strength in axial compression.
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The use of transperitoneal endoscopic approaches to the distal segments of the lumbar spine has recently been described. This has been the catalyst for the development of other minimally invasive anterior approaches to the spine. ⋯ The efficacy and safety of minimal access techniques in the spine have been established, and outcome standards set by which future techniques can be judged. The importance of proper training is emphasised.
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We report on a 15-year-old boy in whom a spontaneous remission of a symptomatic synovial cyst, possibly emanating from the L4-5 facet joint, was noted. The medical history suggested that sport-related overactivity and/or minor trauma was the underlying cause. Conservative treatment for several months may be one treatment option if the cyst wall is not calcified and the symptoms and signs related to radiculopathy show a gradual decrease.
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A 17-year-old patient with pre-existing grade II spondylolisthesis of L5/S1 sustained a partial disruption of the left sacroiliac joint with haematoma of the iliac muscle after a fall. The haematoma probably led to occlusion of the left ureter, resulting in a urinary tract infection. After initial conservative treatment the patient developed fever and radicular pain of the left leg. ⋯ Staphylococcus aureus was identified as the pathogen. At follow-up 6 months postoperatively all symptoms had resolved, while MRI still revealed residual osseous oedema of the sacroiliac joint. The haematoma of the iliac muscle resolved without surgical intervention.