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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Cervical corpectomy is a frequently used technique for a wide variety of spinal disorders. The most commonly used approach is anterior, either with or without plating. The results for single-level corpectomy are better than in multilevel procedures. ⋯ Another benefit could be fewer hardware-related complications, higher fusion rate, larger range of instabilities to be treated by one implant system, less restrictive postoperative treatment and possibly better clinical outcome. From a biomechanical standpoint, in regard to primary stability the constrained systems, therefore, seem to be beneficial. Whether this leads to differences in clinical outcome has to be evaluated in clinical trials.
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In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. ⋯ Pain intensity was evaluated by visual analog scale (VAS), and the patients' function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.
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Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities.
The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at operation was 9.3 years (standard deviation (SD): 2.4). ⋯ It takes about 12 months to recover to pre-surgery level, while small improvement is seen afterwards. After spinal fusion, ambulation often becomes difficult, especially in exercise walkers. These findings are important for health-care professionals, in order to inform and prepare the patients and their parents properly for a planned spinal fusion.
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The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. ⋯ We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.
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Cervical spine fractures in patients with ankylosing spondylitis are serious and potentially lethal injuries with high complication rates. Treatment obstacles include long lever arms that generate large forces on any fixation device, osteoporosis, and, usually, kyphotic deformity. The Olerud Cervical Fixation System (OC), with cervical pedicle screws and rods, offers an opportunity to create a biomechanically stable posterior fixation in these complicated cases. ⋯ Extensive peroperative bleeding was encountered in two patients. One deep-wound infection was noted, postoperatively, and required surgical drainage, but no patients have been re-operated due to loosening of the instrument or to healing problems. In conclusion, the results of the present study indicate that the OC--and possibly other similar long-fixation systems that allow using both pedicle screws and lateral mass screws rigidly connected to a rod--is suited for treating subaxial cervical spine fractures in patients with ankylosing spondylitis, allowing high healing rates.