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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Neurogenic intermittent claudication, caused by lumbar spinal stenosis (LSS), usually occurs after the age of 50 and is one of the most common degenerative spinal diseases in the elderly. Among patients over the age of 65 with LSS, open decompression is the most frequently performed spinal operation. The recently introduced interspinous spacers are a new alternative under discussion. ⋯ The interspinous implant did not worsen low-grade spondylolisthesis. Provided there is a strict indication and fusion is not required, implantation of an interspinous spacer is a good alternative to treat LSS. The interspinous implant offers significant, longlasting symptom control, even if initially significant radiological changes seem to revert toward the initial values ("loss of correction").
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Motor vehicle collision (MVC) is one of the most common causes of thoracolumbar junction (TLJ) injury. Although it is of no doubt that the use of seatbelt reduces the incidence and severity of MVC-induced TLJ injury, how it is protective for front-seat occupants of an automobile after rollover crashes is unclear. Among 200 consecutive patients with a major TLJ (Th11-L2) injury due to high-energy trauma admitted from 2000 to 2004, 22 patients were identified as front-seat occupants of a four-wheel vehicle when a rollover crash occurred. ⋯ It is likely that the high incidence of neurologic deficit in the unbelted group was due to the high incidence of AO type B/C injury. This study indirectly proves the efficacy of seatbelt in reducing the severity of rollover-induced TLJ injury. Because of the limited number of cases, it is uncertain whether ejection from vehicle, which occurs exclusively in the unbelted victims, is a crucial factor in determining the severity or type of injury after rollover crashes.
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Direct removal of the ossified mass via anterior approach carries good decompression to ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Ossification occasionally involves not only the posterior longitudinal ligament but also the underlying dura mater, which increased the opportunity of the cerebrospinal fluid (CSF) leakage or neurological damage. The surgeon was required to recognize the dural ossification (DO) and need more cautious manipulation. ⋯ In this technique, the arachnoid membrane needed to be persevered with the aid of microscope to avoid a large area of membrane defect, resulting in uncontrolled CSF leakage. There was no significant difference in clinical results between the patients with DO and those without DO. Therefore, ACCF is meritorious for the patient with OPLL associated with DO, although more difficult manipulation and higher risk of CSF leakage.
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Extremely severe Pott's kyphotic deformity cannot be completely corrected by conventional techniques, including vertebral body resection, Smith-Peterson, pedicle subtraction osteotomy or even vertebral column resection (VCR). The authors developed a new technique combining transpedicular eggshell osteotomies and VCR as multilevel modified vertebral column resection (MVCR) through a single posterior approach for surgical treatment of Pott's kyphosis with Konstam's angle beyond 90 degrees. A total of 9 patients (6 males, 3 females) in our institution with severe Pott's kyphosis who underwent single-stage posterior-only multilevel MVCR were retrospectively reviewed. ⋯ No pseudoarthrosis was found. No loosening or breakage of pedicle screws occurred. A single-stage posterior-only multilevel MVCR is an effective way to correct extremely severe Pott's kyphosis with Konstam's angle beyond 90 degrees.
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Comparative Study
Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) cause significant morbidity and mortality in orthopaedic surgical practice, although the incidence following surgery to the lumbosacral spine is less than following lower limb surgery. Our objective was to compare our rate of thromboembolic complications with those published elsewhere and investigate whether the adoption of additional pharmacological measures reduced the incidence of clinically evident DVT and PE. This retrospective study was undertaken to investigate the incidence of DVT/PE during the 10 years from 1 January 1985 to 31 December 1994, and then to assess the effectiveness of an anticoagulant policy introduced during 1995 using low dose aspirin or LMH in high risk cases. ⋯ A total of 697 operations were performed from 1 January 1985 to 31 December 1994 with two cases of DVT and no cases of PE giving thromboembolic complication rate of 0.29%. During the period 1 January 1996 to 31 December 2003, 414 operations resulted in one case of DVT and no cases of PE, a rate of 0.24%. The incidence of symptomatic thrombo-embolic complications in lumbar spinal surgery is low in the kneeling, seated prone operating position, whether or not anticoagulation is used.