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 Comparative Study Clinical Trial
Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion.
In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. ⋯ One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.
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Segmental instability represents one of several different factors that may cause or contribute to the failed back surgery syndrome after lumbar microdiscectomy. As segmental lumbar instability poses diagnostic problems by lack of clear radiological and clinical criteria, only little is known about the occurrence of this phenomenon following primary microdiscectomy. Retrospectively, the records of 2,353 patients were reviewed according to postoperative symptomatic segmental single-level instability after lumbar microdiscectomy between 1989 and 1997. ⋯ It can therefore be concluded that (1) patients in their 40s are prone to postoperative narrowing of the intervertebral disc space and hence subsequent intervertebral instability and (2) that a small extent of intervertebral disc resection and preservation of the "segmental frame" may be beneficial in those patients. The present study demonstrated for the first time that the degree of extensive operative techniques in microdiscectomy increased the risk of subsequent segmental instability. In addition, narrowing of the intervertebral space of more than 30% represents a clear radiological sign of segmental instability.
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Review Case Reports
Primary amyloidoma of the axis and acute spinal cord compression: a case report.
Localized primary amyloidosis is a disease characterized by a single tumor and localized amyloid deposit (amyloidoma) with no evidence of generalized amyloidosis. The occurrence of an amyloidoma in the spine is rare and only three cases affecting the axis have been previously reported. We describe the case of a 79-year-old woman presenting with a mass involving the odontoid process, responsible for an acute tetraparesia. Diagnosis of local primary amyloidosis was made after surgical excision. ⋯ Amyloidoma must be discussed in presence of a tumor-like mass of the odontoid process and may be responsible, as in our case, for spinal cord compression.
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The purpose of the study was to investigate possible variation of thickness of the cervical spine endplate with respect to endplate orientation (superior or inferior endplate) and level distribution (C4-C7). Six human cervical spine segments C4-C7 were used to create six specimen of C4, C5, C6, and C7, respectively. The bony endplates of each vertebra were cleaned carefully from disc tissue without damaging the endplates. ⋯ In both superior and inferior endplates, peripheral areas were thicker than the central region (Scheffe-test, P<0.001). For all levels, the endplate within the peripheral regions was thicker than within the central region and the difference reached significance for the superior and inferior endplate of C4, C5, and C6 and the inferior endplate of C7 (Scheffe-test, P<0.05). The peripheral regions of the cervical spine endplate are usually thicker than its central region, regardless of endplate orientation and level (C4, C5, C6, C7) distribution.
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There is no generally accepted scientific theory for the etiology of idiopathic scoliosis. As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate of extant knowledge on important topics. This has been designated as an on-line Delphi discussion. ⋯ To explain the relationship of platelet calmodulin levels to scoliosis curve changes in AIS brought about spontaneously, by brace treatment, or surgery Dr Lowe attributes the platelet calmodulin changes to paraspinous muscle activity and suggests that the calmodulin acts as a systemic mediator of tissues having a contractile system (actin and myosin). Controversy includes: 1) the lack of normal data and the large variability in baseline levels of platelet calmodulin, necessitating the use of the AIS subjects as their own controls; 2) calmodulin is not usually used as a marker of platelet activation; 3) whether the platelet calmodulin changes which appear to reflect an abnormality of a portion of the spine are related to local and/or regional changes in muscles, nervous system, or immature vertebrae. What is not controversial is the need for more research on platelets and the immature deforming skeleton in relation to etiology and prognosis.