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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Review Case Reports
C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases.
Postoperative C5 palsy is a common complication after cervical spine decompression surgery. However, the incidence, prognosis, and etiology of C5 palsy after anterior decompression with spinal fusion (ASF) have not yet been fully established. In the present study, we analyzed the clinical and radiological characteristics of patients who developed C5 palsy after ASF for cervical degenerative diseases. ⋯ In the ten patients with a MMT grade ≤2 at the onset, nine patients showed HSCs at the C3-C4 and C4-C5 levels. The present findings demonstrate that, in most patients with severe C5 palsy after ASF, pre-existing asymptomatic damage of the anterior horn cells at C3-C4 and C4-C5 levels may participate in the development of motor weakness in combination with the nerve root lesions that occur subsequent to ASF. Thus, when patients with spinal cord lesions at C3-C4 and C4-C5 levels undergo multilevel ASF, we should be alert to the possible occurrence of postoperative C5 palsy.
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Randomized Controlled Trial
Risk factors for deep surgical site infections after spinal fusion.
Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. ⋯ Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications.
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Comparative Study
Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2.
Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury, postoperative pain and disability while allowing the surgery to be conducted in an effective manner. There have been no prospective clinical reports published on the comparison of one-level transforaminal lumbar interbody fusion in low-grade spondylolisthesis performed with an independent blade retractor system or a traditional open approach. ⋯ Minimally invasive TLIF has similar surgical efficacy with the traditional open TLIF in treating one-level lower grade degenerative or isthmic spondylolisthesis. The minimally invasive technique offers several potential advantages including smaller incisions, less tissue trauma and quicker recovery. However, this technique needs longer X-ray exposure time.
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Comparative Study
Comparison of enlargement of the spinal canal after cervical laminoplasty: open-door type and double-door type.
The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. ⋯ At both the C5 and C6 levels, it was significantly larger in DDL than TBL (p < 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery.