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
-
This prospective study with independent clinical review was set up to monitor the clinical outcome of patients when using serial periradicular/epidural corticosteroid injection techniques in managing cervical radiculopathy. Over a 10 year period, between 1986 and 1995, a consecutive series of 68 secondary referral patients presenting with cervical radiculopathy were entered into the study. There were 57 men (84%) and 11 women (16%) of average age 47 years (range 31-65 years). ⋯ Despite the fact that all 68 patients were potential surgical candidates, they all made a satisfactory recovery without the need for surgical intervention. Forty-eight patients (76%) did not experience any arm pain, and of the 15 patients (24%) who did, this improved from 10 to an average of 2 (range 1-4) on a 10-point pain scale. Thus, patients with cervical radiculopathy make a satisfactory recovery with serial periradicular/epidural corticosteroid injections without the need for surgical intervention.
-
We report on two children with tuberculosis of the craniocervical junction. Atlantoaxial instability was evident in both patients due to the destruction of the dens and the atlantoaxial ligaments. ⋯ Despite anti-tuberculosis treatment and immobilization, atlantoaxial instability was evident on flexion/extension views. Successful fusion of C1 and C2 was performed in both patients.
-
Review Case Reports
Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature.
A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evacuate her bladder and control her micturition. ⋯ A self-catheterisation regime was instituted with a diagnosis of parasympathetic nerve injury during the anterior spinal fusion. After a period of 3 months, the patient regained control of urination. We report this case to highlight the importance of protecting the parasympathetic presacral nerve during L5-S1 anterior interbody fusion, as injury to this nerve affects urinary evacuation.
-
In this study a series of 32 patients with idiopathic scoliosis, managed with selective thoracic fusion, was reviewed. Classified according to King and instrumented with the H-frame, the patients were evaluated for curve correction, rib hump correction and postoperative shift in lumbar rotation. Age and follow-up average 19.4 and 2.4 years, respectively. ⋯ This en bloc rotation of the unfused lumbar segments is induced by the correcting forces applied by the instrumentation. The unfused lumbar spine of a patient with a King type II curve shows a larger lumbar rotation shift and subsequent rib hump correction than that of a patient with a King type III curve. Together with factors such as lateral angulation, rib-vertebra angles and structural limitations, the rotational dynamics of the unfused lumbar spine seem to form an important component in the under-standing and surgical management of scoliosis.
-
Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979-1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. ⋯ The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.