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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Fifty patients with thoracolumbar fractures were treated by internal fixation using the Dick fixator. In the first 22 patients (group 1) this was accompanied by posterior intertransverse grafting. The technique was then modified in the following 28 patients (group 2) to include transpedicular elevation of the depressed vertebral end plate and grafting of the vertebral body, in an attempt to reduce the postoperative loss of correction of the kyphotic deformity. ⋯ There was no difference in the complication rate between the two groups and no complication attributable to transpedicular bone grafting. The radiological results postoperatively and at a mean follow-up period of 9 months were assessed by measurement of the kyphosis angle, anterior vertebral height, anterior displacement, scoliosis, and reduction in cross-sectional area of the spinal canal. In group 1 the mean preoperative kyphosis angle and anterior vertebral height were 8 degrees and 21 mm; postoperatively these values were -12 degrees (lordosis) and 27 mm; and at follow-up they were -4 degrees and 24 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. ⋯ During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.
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An anatomical study of the cervical spinal cord and root to investigate the mechanism of paralysis of the arm after posterior decompression was performed using 14 cadavers of Japanese adults. It revealed that in the intervertebral foramen, extradural portions of the anterior and posterior roots of the cervical spinal cord lay separately in caudal-rostral relation, and the anterior root passed through the narrowest portion of the foramen isolatedly, i.e. the superior notch of the superior articular process. After laminectomy, a posteromedial shift of the dura-root junction occurred in combination with the posterior enlargement of the dual tube, and it showed two effects on the roots, one a relaxing effect on rootlets and the other, a traction effect on the extradural portion of a root. ⋯ With anchoring of the anterior root inside the foramen, a traction injury of the anterior root develops. The predominance of paralysis at the middle cervical level could be explained by the higher degree of anterior protrusion of the superior articular process and the more frequent degenerative changes here than at other levels. These factors might inhibit the gliding abilities of the roots inside the foramina, with the formation of perineural fibrosis, predisposing the roots to damage by the traction force.
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Surgical treatment of unstable traumatic injuries of the cervical spine can be carried out by a posterior or anterior approach, with different advantages and disadvantages. Twenty patients were treated with anterior decompression, interbody fusion with autogenous iliac bone graft, and osteosynthesis with a Louis anterior plate. The screws were inserted in the vertebral body without reaching the posterior vertebral wall. ⋯ Anterior plate instrumentation has proved itself mechanically adequate, even if it is less stable than posterior constructs. The advantages of anterior surgery compared to those of posterior surgery are such that several specific risks are acceptable. Posterior surgery is nevertheless indicated if the lesion cannot be reduced preoperatively under closed conditions.
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Summary. The results of 23 patients with symptomatic spondylolysis or mild isthmic spondylolisthesis treated by Scott's direct repair of the defect (secclusion) were analyzed with particular reference to spinal mobility and the condition of the intervertebral discs, and compared with the outcome of 25 patients treated by posterolateral segmental fusion without instrumentation. The two groups were comparable as to age at operation (17.4 +/- 5.7 vs. 15.6 +/- 2.6 years), follow-up time (54 +/- 8 vs. 54 +/- 25 months), gender, and preoperative subjective symptoms. ⋯ At this point of follow-up it is impossible to say which of the two procedures should be preferred for operative treatment of this condition in young patients. Direct repair does not protect the disc of the lytic/olisthetic segment from further degeneration. Pathologic disc changes in MRI should be interpreted with caution because their clinical relevance is still unclear.