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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Surgical treatment of Tarlov cysts is still a matter of debate. Published literature thus far includes mainly small case series with retrospective evaluation and short-term follow-up. We present a novel microsurgical technique that combines the decompression of the nerve fibers with the prevention of recurrence. The long-term follow-up is provided. ⋯ The inverted plication technique combined with sacroplasty is a promising technique. It improves pain and neurological deficits on the long term in the majority of patients with symptomatic Tarlov cysts.
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In adult spinal deformity (ASD), patients increase pelvic tilt (PT) to maintain standing alignment. Previously, ASD patients with low PT and high disability were described. This study investigates this unusual population in terms of demographic, radiographic, and clinical features after three-column osteotomy (3CO). ⋯ LowPT group had high levels of disability. After 3CO surgery, low PT patients experience only partial improvements in sagittal vertical axis (SVA) and 33 % of the group increased their PT. Further work is necessary to determine optimal realignment approaches for this unusual set of patients. It is unclear if neuromuscular pathology plays a role in the setting of high SVA without pelvic retroversion.
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To determine whether the presence of intervertebral bridging ossifications is associated with intravertebral cleft (IVC) formation following a vertebral compression fracture (VCF). ⋯ A fresh VCF with bridging ossification at the second proximal intervertebral level is associated with increased risk of IVC formation. Careful observation and strict conservative treatment are recommended in such cases.
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Pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) are important parameters in sagittal spine alignment evaluation. The measurements are a projection of the three-dimensional pelvis onto a two-dimensional radiograph and they may be influenced by orientation of the pelvis. The aim of this study was to assess the influence of pelvic rotation in the coronal plane (CPR) on radiographic accuracy of PI, PT, and SS measurements. ⋯ Rotation of the pelvis in the coronal plane during acquisition of radiographs influences PI, PT and SS measurements. Substantial error of PI, PT and SS measurements occurs with CPR of more than 20° which is equivalent to a lower limb discrepancy of 5.2 cm. CPR may be calculated while acquiring the radiograph. Further evaluation of the influence of CPR on spinopelvic parameters with a larger sample would be valuable.
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Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly. ⋯ Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.