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
-
Postoperative visual loss associated with spine surgery is a rare complication with no established definitive etiology. Multiple case reports have been published in the literature, and an overview of the case reports of the various visual disturbances following spine surgery is presented. Our objective was to review the current literature and determine if there were any risk factors that suggest what kind of patients have a higher likelihood of developing postoperative visual loss. ⋯ The etiology of postoperative visual loss is probably multifactorial, however, patients with a large amount of blood loss producing hypotension and anemia along with prolonged operative times may be causing a greater risk in developing visual disturbances. An acute anemic state may have an additive or synergistic effect with other factors (medical comorbidities) leading to visual disturbances. Although our study failed to provide definitive causative factors of postoperative visual loss, suggestions are made that warrant further studies.
-
A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93 degrees, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. ⋯ In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.
-
This study was conducted to refine a small animal model of scoliosis, and to quantify the deformities throughout its growth period. Subcutaneous scapula-to-contralateral pelvis tethering surgery was selected due to its minimally invasive nature and potential applicability for a large animal model. The procedure was performed in 7-week-old New Zealand white rabbits. ⋯ In conclusion, this tethering technique in immature rabbits consistently produced scoliosis with vertebral wedging when the tether was intact through the first 2 months of the protocol. The transient exaggeration of kyphosis suggests that the production of scoliosis is not necessarily dependent on lordosis in this model. Because this technique does not violate thoracic or spinal tissues, it may be useful in the investigation of secondary physiologic effects of mechanically-induced scoliosis, and may be scalable to larger animal species.
-
Cervical osteotomy can be performed on patients with cervical kyphosis due to ankylosing spondylitis. This study reviews the role of two new developments in cervical osteotomy surgery: internal fixation and transcranial electrical stimulated motor evoked potential monitoring (TES-MEP). ⋯ We conclude that C7 osteotomy with internal fixation has been shown to be a reliable and stable technique. When surgery is performed the in prone position, distal fixation can be optimally obtained allowing post-operative treatment by cervical orthosis instead of a halo-cast. TES-MEP monitoring has been shown to be a reliable neuromonitoring technique with high clinical relevancy during cervical osteotomy because it allows timely intervention before occurrence of permanent cord damage in a large proportion of the patients.
-
The objective of this study was to evaluate which fusion technique provides the best clinical and radiological outcome for adult low-grade lumbar isthmic spondylolisthesis, and to assess the overall clinical and radiological outcome of each fusion technique. A systematic review was performed. Medline, Embase, Current Contents, and Cochrane databases as well as reference lists of selected articles were searched. ⋯ The current study could not identify the best surgical technique (PLF, PLIF, ALIF, instrumentation) to perform the fusion. However, instrumentation and/or decompression may play a beneficial role in the modern practice of reduction and fusion for low-grade isthmic spondylolisthesis, but there are no studies yet available to confirm this. The outcomes of fusion are generally good, but reports vary widely.