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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Eighty consecutive cases of suprafascial pedicle screw stabilization were reviewed. Intraoperative fluoroscopy aided the percutaneous screw placement after structural anterior interbody graft(s) were placed. During routine outpatient hardware removal, all intradiscal fusions were stressed via the Shanz screws under fluoroscopy. Anterior reconstruction via a mini open approach coupled with this minimally invasive posterior approach led to a 96% successful fusion rate.
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Endoscopic surgery of the thoracic spine has up to now been considered as an experimental procedure. Reports published in recent years have shown that the results achieved with this technique are as good as, or for some indications superior to, those reported for classic open approaches. A review of the indications, limitations, advantages and disadvantages is presented. Although there is still resistance to acknowledging the effectiveness of this procedure, experience has shown that the results are as good, complications are fewer and postoperative recovery is improved, thus shortening the total hospitalization time.
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This review will summarize the major efforts currently underway to develop osteoinductive bone graft substitutes for minimally invasive spine fusions. The primary categories of substitute include purified bone growth factors, recombinant bone growth factors, and growth factors delivered by gene therapy approaches. Clinical trials are underway for the purified and recombinant bone growth factors and pre-clinical studies have yielded promising results for a variety of gene therapy techniques for generating bone.
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Indications and timing of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the conditions, were reviewed. Advances in spinal imaging and accumulation of clinical experience have provided some clues as to indications and timing of surgery for cervical myelopathy. Duration of myelopathy prior to surgery and the transverse area of the spinal cord at the maximum compression level were the most significant prognostic parameters for surgical outcome. ⋯ When surgery is properly carried out, long-term surgical results are expected to be good and stable, and the natural course of myelopathy secondary to cervical spondylosis may be modified. However, little attention has been paid to the questions "When and what can surgery contribute to treatment of cervical radiculopathy?". A well-controlled clinical study including natural history should be done to provide some answers.
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Comparative Study
The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine.
Transpedicular screw fixation has recently been shown to be successful in stabilizing the middle and lower cervical spine. Controversy exists, however, over its efficacy, due to the smaller size of cervical pedicles and the proximity of significant neurovascular structures to both lateral and medial cortical walls. To aid the spinal surgeon in the insertion of pedicle screws, a number of studies have been performed to quantify the gross dimensions and angulations of the cervical pedicle. ⋯ The pedicle slices were found to exhibit substantial variability in composition and shape, not only between individual spines and vertebral levels, but also within the pedicle axis. However, the lateral cortex was consistently found to be thinner than the medial cortex in all samples. These physical findings must be noted by surgeons attempting transpedicular screw fixation in the cervical spine.