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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Clinical Trial
The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device.
With lumbar discectomy for disc herniation, surgeons must choose between limited nucleus removal associated with higher reherniation risk or more aggressive nucleus removal associated with increased back pain and disc degeneration. This trade-off is particularly challenging in patients with large anular defects, which carry the highest risk of reherniation. We examined the effect of an anular closure device on reherniation and clinical outcomes. ⋯ The low reherniation rate in patients at high-risk of reherniation based on anular defect size, despite discectomy being only limited, suggests that an anular closure device may reduce reherniation risk. Clinical outcomes for pain and function at 1 and 2 years post-operatively compared favorably with literature reports. Further study in a randomized controlled trial is required to confirm these results.
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Many studies regarding spinal sagittal alignment were focused mainly on above-hip structures, not considering the knee joint. Knee-spine syndrome was proposed earlier, but the mechanism of this phenomenon has not been revealed. The aim of the study was to demonstrate how spinopelvic alignment and sagittal balance change in response to simulated knee flexion in normal non-diseased population. ⋯ The knee flexion resulted in decrease of lumbar lordosis without a significant change of pelvic posture in non-diseased population group.
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Ossification of the ligamentum flavum (OLF) is rarely identified in cervical spine and its pathogenesis has not been established. We report a case of multiple-level OLF, combined with the calcification of the cervical ligamentum flavum and posterior atlanto-axial membrane. ⋯ Simultaneous development of cervical OLF and CLF in this case seems unlikely to have occurred coincidentally and suggests that the pathogenesis of OLF and CLF may share a common initiation factor.
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Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. ⋯ We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required.
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Pure hyperextension thoracolumbar spinal fractures are unusual and occur primarily in patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis due to the rigidity of the spine. ⋯ This case reports a rare distractive extension injury in the lower lumbar spine with ureteral impingement. One should be aware of possible complications such as ureteral impingement following a pure hyperextension injury in the lower lumbar spine.