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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Randomized Controlled Trial Clinical Trial
Predictive factors for the outcome of anterior cervical decompression and fusion.
In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. ⋯ At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.
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We retrospectively analysed ten consecutive patients (age range 32-77 years) treated surgically from 1994 to 1999 for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. Clinically, eight patients had varying grades of back pain and eight patients had paraparesis. Radiography showed calcification in 50% of the herniated discs. ⋯ He developed severe back pain and generalised hyper-reflexia following corpectomy and fusion for disc herniation at T10/11. We advocate anterior transthoracic discectomy following partial corpectomy for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. This procedure offers improved access to the thoracic disc for an instrumented fusion, which is likely to decrease the risk of iatrogenic injury to the spinal cord.
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More than a quarter of patients with spinal cord injury develop syringomyelia, often with progressive neurological deficit. Treatment options remain limited and long-term failure rates are high. The current poor understanding is impeding development of improved therapies. ⋯ This is the first report of fluid flow within the spinal cord in a model of post-traumatic syringomyelia. Fluid from perivascular spaces moves preferentially into extracanalicular syringes and the surrounding parenchyma. Obstruction to CSF flow and loss of compliance from traumatic arachnoiditis might potentiate fluid flow in the perivascular space.
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Review Multicenter Study Guideline
Classification and management of early complications in open lumbar microdiscectomy.
Complications and side effects in any kind of surgery, especially in spine surgery, should be evaluated to prevent those problems in the future. Since retrospective studies are of minor value and randomized controlled studies for complications are impossible to perform because of ethical and legal reasons, so-called "expert opinion" has to take their place in evidence-based medicine. On the basis of an analysis of the results of three spine centers together with the opinions of experienced spine surgeons, the authors have drawn up a classification of complications in open lumbar disc surgery and recommendations on how to manage common complications such as excessive bleeding, dural opening, nerve root lesions and recurrent disc herniation. The management of intraoperative complications should have the same training in microdiscectomy instructional courses as the operation itself.
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A newly designed technique for a minimally invasive approach to the laterally herniated disc is presented. Fifteen patients suffering from far lateral disc herniation (extraforaminal) were operated according to this technique. Through a small skin incision (1.5 cm), the paraspinal muscles are spread by dilators, until a working channel of 9 mm inner diameter and 11 mm outer diameter can be placed. ⋯ No intra-operative or early postoperative complications occurred. However, one recurrence did occur, which was treated by the same technique. This technique combines the advantages of three-dimensional visual control (operating microscope) with the minimal surgical trauma of endoscopic techniques, while avoiding some of the shortcomings of both the microsurgical and endoscopic techniques.