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
-
Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. ⋯ Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed.
-
Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. ⋯ Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.
-
Multilevel cervical spine procedures can challenge the stability of current anterior cervical screw-and-plate systems, particularly in cases of severe three-column subaxial cervical spine injuries and multilevel plated reconstructions in osteoporotic bone. Supplemental posterior instrumentation is therefore recommended to increase primary construct rigidity and diminish early failure rates. The increasing number of successfully performed posterior cervical pedicle screw fixations have enabled more stable fixations, however most cervical pathologies are located anteriorly and preferably addressed by an anterior approach. ⋯ On the basis of these results, standard spine models were reconstructed and used for the conceptual development of a preclinical release prototype of an anterior transpedicular screw-and-plate system. The morphological feasibility of the new technique is demonstrated, and its indications, biomechanical considerations, as well as surgical prerequisites are thoroughly discussed. In the future, the technique of cervical anterior transpedicular screw fixation might diminish the number of failures in the reconstruction of multilevel and three-column cervical spine instabilities, and avoid the need for supplemental posterior instrumentation.
-
Reconstruction after multilevel decompression of the cervical spine, especially in the weakened osteoporotic, neoplastic or infectious spine often requires circumferential stabilization and fusion. To avoid the additional posterior surgery in these cases while increasing rigidity of anterior-only screw-plate constructs, the authors introduce the concept of anterior transpedicular screw (ATPS) fixation. We demonstrated its morphological feasibility as well as its indications in a previous study in Part I of our project. ⋯ The study demonstrated that the use of ATPS might be a new technique worthy of further investigation. The use of ATPS shows the potential to increase construct rigidity in terms of screw-plate pull-out resistance. It might diminish construct failures during anterior-only reconstructions of the highly unstable decompressed cervical spine.
-
Several techniques have been described for selective nerve root blocks. We describe a novel 'two-needle technique', performed through the postero-lateral route with the patient in lateral position under C-arm guidance. The aim of the current study is to highlight the effectiveness and safety of cervical selective nerve root block for radiculopathy using this technique. ⋯ Mean duration of radiation exposure during the procedure was 27.8 s (range 10-90 s). Only minor complications were noted-transient dizziness in two and transient nystagmus in one patient. Our 'two-needle technique' is a new, safe and effective non-surgical treatment for cervical radiculopathy.