Journal of spinal disorders
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Review Case Reports
Sudden sensorineural hearing loss after spinal surgery under general anesthesia.
Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. ⋯ Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.
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Case Reports
Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis.
The aims of the current study were to evaluate the long-term clinical and radiologic results of anterior lumbar interbody fusion (ALIF) for isthmic spondylolisthesis. Between 1981 and 1988, a total of 35 patients underwent ALIF for isthmic spondylolisthesis. Of these, 23 patients were followed clinically and radiographically for more than 10 years (average, 13.3 years). ⋯ The rate of union in the grafted area was 83%. In the nonunion cases, the scores gradually deteriorated with time, but the overall results were not different from those of union cases. Radiographs showed adjacent disk degeneration in 52% of cases in the upper adjacent level and in 70% of cases in the lower adjacent level, but these changes were not correlated with clinical outcomes.
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Lumbar interbody fusion can be performed anteriorly or posteriorly. An anterior approach generally requires an access surgeon and often is combined with a posterior fusion. A traditional posterior interbody fusion can destabilize the spinal motion segment and requires neural retraction. ⋯ This cost comparison was conducted only for the time of the operative procedure. No attempt was made to analyze rates of fusion between the two groups or ultimate clinic outcome. There were no major complications in either group, and no patient returned to surgery for a lumbar spinal problem at the authors' hospital within 1 year of the index procedure.
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This anatomic study investigated the thoracic pedicle and its relations. The objective was to emphasize the importance of the thoracic pedicle for transpedicular screw fixation to avoid complications during surgery. Twenty cadavers were used to observe the cervical pedicle and its relations. ⋯ The nerve root diameter was between 2.3 and 2.5 mm at the T1-T5 level and then increased consistently from 2.5 to 3.7 mm. All significant differences were noted at p < 0.05 and p < 0.01. The following suggestions are made based on these results. 1) More care should be taken when a transpedicular screw is placed in the horizontal plane. 2) Improper medial placement of the pedicle screw, especially in the middle thoracic spine, should be avoided, and the anatomic variations between individuals should be considered. 3) Because of substantial variations in the size of thoracic pedicles, utmost attention should be given to the findings of a computed tomographic evaluation before thoracic transpedicular fixation is begun.
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Clinical Trial
Cervical spondylosis: the role of anterior instrumentation after decompression and fusion.
The role of plate stabilization after anterior decompression and fusion of the cervical spine for cervical spondylosis remains controversial. This study aimed to justify the use of instrumentation to stabilize anterior cervical fusion for cervical spondylosis through a risk-benefit analysis and comparison of the results with those reported in the literature on the outcome of fusion without instrumentation. The authors retrospectively reviewed the charts and radiographs of 47 patients with symptoms secondary to cervical spondylosis who underwent anterior cervical decompression and instrumented fusion. ⋯ Accelerated degenerative changes at levels adjacent to the fusion were seen in 17% of patients, but only two patients required repeat operation for persistent symptoms. The use of instrumentation to stabilize the cervical spine in patients with cervical spondylosis after anterior decompression and fusion is relatively safe. It permits early pain-free mobilization, successfully maintains sagittal cervical spine alignment, and promotes consistent and reliable spinal fusion.