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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Multicenter Study Comparative Study
Incidental durotomy in lumbar spine surgery: incidence and management.
There is increasing awareness of the need to inform patients of common complications that occur during surgical procedures. During lumbar spine surgery, incidental tear of the dural sac and subsequent cerebrospinal fluid leak is possibly the most frequently occurring complication. There is no consensus in the literature about the rate of dural tears in spine surgery. ⋯ The rate was 3.5% for primary discectomy, 8.5% for spinal stenosis surgery and 13.2% for revision discectomy. There was a wide variation in the actual and estimated rates of dural tears among the spine surgeons. The results confirm that prospective data collection by spine surgeons is the most efficient and accurate way to assess complication rates for spinal surgery.
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Comparative Study
Dynamic electrophysiological examination in patients with lumbar spinal stenosis: is it useful in clinical practice?
Neurogenic claudication (NC) is typical of lumbar spinal stenosis (LSS). One suspected pathophysiological mechanism underlying NC is intermittent hypoxia of cauda equina fibres resulting from venous pooling, which may lead to ischaemic nerve conduction failure and to transient clinical and electrophysiological changes after exercise. The aim of this study was to evaluate the appearance of significant transient electrophysiological abnormalities after walking exercise in patients with LSS and to establish the contribution of dynamic electrophysiological examination in the differential diagnostics of patients with LSS. The study participants were 36 consecutive patients with LSS demonstrated by computed tomography (CT). The control groups included, respectively, 28 patients with diabetes mellitus and clinically manifested polyneuropathy, and 32 healthy volunteers. The LSS patients were divided into four subgroups based on the clinical severity of the disease (with respect to the presence or absence of NC in the history and pareses on neurological examination). Soleus H-reflex, tibial F-wave and motor evoked potentials (MEPs) to abductor hallucis muscle were examined in all groups, before and after quantified walking on a treadmill. The electrophysiological parameters measured after an exercise treadmill test (ETT) in LSS patients and in both control groups were compared with the same parameters obtained before ETT. The study shows that the electrophysiological parameters reveal minimal but statistically significant changes after walk loading in patients with LSS (a prolongation of the minimal latency of the tibial F-wave and of the latency of the soleus H-reflex). The changes in these parameters were demonstrated not only in patients with NC but also in patients without NC. More pronounced changes were found in LSS patients exhibiting chronic lower extremity pareses. ⋯ From among a large battery of electrophysiological tests, only the minimal latency of the tibial F-wave and the latency of the soleus H-reflex exhibit changes after walk loading in patients with LSS. These are minimal but statistically significant. Dynamic electrophysiological examination can illustrate the pathophysiology of NC in LSS, but from a practical point of view its contribution to the differential diagnostics of LSS or diabetic polyneuropathy is limited by an absence of established cut-off values.
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Historical Article
Anterior thoracic posture increases thoracolumbar disc loading.
In the absence of external forces, the largest contributor to intervertebral disc (IVD) loads and stresses is trunk muscular activity. The relationship between trunk posture, spine geometry, extensor muscle activity, and the loads and stresses acting on the IVD is not well understood. The objective of this study was to characterize changes in thoracolumbar disc loads and extensor muscle forces following anterior translation of the thoracic spine in the upright posture. ⋯ Anterior translation of the thorax resulted in significantly increased loads and stresses acting on the thoracolumbar spine. This posture is common in lumbar spinal disorders and could contribute to lumbar disc pathologies, progression of L5-S1 spondylolisthesis deformities, and poor outcomes after lumbar spine surgery. In conclusion, anterior trunk translation in the standing subject increases extensor muscle activity and loads and stresses acting on the intervertebral disc in the lower thoracic and lumbar regions.
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Comparative Study
Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures.
Previous clinical studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of pathological vertebral compression fractures (VCFs). However, they have not dealt with the impact of relatively common comorbid conditions in this age group, such as spinal stenosis, and they have not explicitly addressed the use of imaging as a prognostic indicator for the restoration of vertebral body height. Neither have these studies dealt with management and technical problems related to surgery, nor the effectiveness of bone biopsy during the same surgical procedure. This is a prospective study comparing preoperative and postoperative vertebral body heights, kyphotic deformities, pain intensity (using visual analogue scale) and quality of life (Oswestry disability questionnaire) in patients with osteoporotic vertebral compression fractures (OVCFs) and osteolytic vertebral tumors treated with balloon kyphoplasty. ⋯ Associated spinal stenosis with OVCF should not be overlooked; STIR MRI is a good predictor of deformity correction with balloon kyphoplasty. The prevalence of a new OVCF in the adjacent level is low.
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Comparative Study
Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems.
Three different anterior plate-fixation systems are available for the stabilisation of the cervical spine: (1) the cervical spine locking plate (CSLP), (2) dynamic plates allowing vertical migration of the fixation screws, and (3) various types of plates that are secured with either monocortical or bicortical unlocked screws. Unicortical screw purchase does not involve the risk of posterior cortex penetration and possible injuries to the spinal cord. The development of locking plates with unicortical screw-fixation and intrinsic stability of the screw-plate interface, via an angle-stabilised connection, was an attempt to increase the stability of unicortical screw-fixation systems. ⋯ Direct comparison of the fixed cervical spine segments with unlocked and locked anterior-plate fixation did not demonstrate significant differences. This in vitro study documented that neither locked nor unlocked anterior-plate fixation can increase stability in all modes of testing. H-plate spondylodesis with unlocked screws seems to provide sufficient mechanical integrity in most cases of monosegmental lesions.