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
-
The treatment of rigid and severe scoliosis and kyphoscoliosis is a surgical challenge. Presurgical halo-gravity traction (HGT) achieves an increase in curve flexibility, a reduction in neurologic risks through gradual traction on a chronically tethered cord and an improvement in preoperative pulmonary function. However, little is known with respect to the ideal indications for HGT, its appropriate duration, or its efficacy in the treatment of rigid deformities. ⋯ The improvement of pulmonary function and the restoration of sagittal and coronal balance are the main goals in the treatment of severe and rigid scoliosis and kyphoscoliosis. A review of the literature showed that HGT is a useful tool for selected patients. Preoperative HGT is indicated in severe curves with moderate to severe pulmonary compromise. HGT should not be expected to significantly improve severe curves without a prior anterior and/or posterior release. The data presented in this study can be used in future studies to compare the surgical and pulmonary outcomes of severe and rigid deformities.
-
Based on the neuroprotective effects of granulocyte colony-stimulating factor (G-CSF) on experimental spinal cord injury, we initiated a clinical trial that evaluated the safety and efficacy of neuroprotective therapy using G-CSF for patients with worsening symptoms of compression myelopathy. ⋯ The results indicate that G-CSF administration at 10 μg/kg/day is safe for patients with worsening symptoms of compression myelopathy and may be effective for their neurological improvement.
-
Comparative Study
A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy.
The optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM) has not been defined, and the relative merits of multilevel anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy (2-level or skip 1-level corpectomy) and fusion (ACCF) remain controversial. However, few comparative studies have been conducted on these two surgical approaches. ⋯ Surgical managements of 3- or 4-level CSM by ACDF or ACCF showed no significant differences in terms of achieved clinical symptom improvements, with the exception of better postoperative NDI scores in ACDF. In addition, ACDF is better than ACCF in terms of blood loss, lordotic curvature improvement and instrumentation and graft related-complication rates, with the exception of operation times.
-
Comparative Study
Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation.
The purpose of this experimental study was to analyse cervical spine kinematics after 1-level and 2-level total disc replacement (TDR) and compare them with those after anterior cervical arthrodesis (ACA) and hybrid construct. Kinematics and intradiscal pressures were also investigated at adjacent levels. ⋯ Although 1- and 2-level TDR restored only partially native kinematics of the cervical spine, these constructs generated better biomechanical conditions than arthrodesis at adjacent levels limiting contribution of these segments to global ROM and reducing the amount of their internal stresses.
-
Comparative Study
Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study.
To compare the results after hemivertebra resection through a single posterior approach and through a combined anterior and posterior approach. ⋯ Similar correction of the main and the compensatory curves can be achieved with single posterior and combined anterior and posterior hemivertebra resection. Benefits of the SPA are lower complication rate and shorter recovery period.