The spine journal : official journal of the North American Spine Society
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Total disc arthroplasty serves as the next frontier in the surgical management of intervertebral discogenic pathology. ⋯ The implementation of dynamic spinal stabilization systems for fusionless correction of spinal deformity, dynamic posterior stabilization and total disc arthroplasty necessitates improved understanding with regard to spinal kinematics, patterns and mechanisms of histologic osseointegration and the neurohistopathologic response to particulate wear debris. Collectively, the current studies provide a methodologic basis to comprehensively evaluate these three areas.
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Comparative Study
In vitro measurement of pressure in intervertebral discs and annulus fibrosus with and without annular tears during discography.
Discogram studies have shown that pain reproduction correlates with the extent of annular disruption. However, it has not been assessed if pressure changes in the annulus fibrosus vary incrementally with intradiscal pressure. ⋯ Volumetric injection of intervertebral discs with a torn annulus fibrosis during discography may increase intra-annular pressure similar to the increase in pressure that may occur during spinal loading activities. This effect may not occur in discs with an intact annulus fibrosus.
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Most surgeons have thought that posterior decompression is necessary to treat isthmic spondylolisthesis with leg pain. However, the surgical procedure not only requires wide muscle dissection but can also lead to spinal instability. The authors' treatment concept for isthmic spondylolisthesis is one-stage anterior reduction and posterior stabilization with minimally invasive surgical procedure without touching the spinal thecal sac and nerve. ⋯ Mini-ALIF followed by percutaneous PF is an efficacious alternative for low-grade isthmic spondylolisthesis, and posterior decompression is not necessary to relieve leg symptoms. This minimally invasive combined procedure offers many advantages, such as preservation of posterior arch, no nerve retraction, less blood loss, excellent cosmetic results, high fusion rate and early discharge.
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It is known that postoperative motor palsy at the C5 level occurs with anterior decompression or posterior decompression and has a relatively good prognosis, but the pathogenesis and possible prophylactic measures of the palsy remain unknown. ⋯ There were no specific risk factors among the preoperative clinical findings related to C5 palsy. Bilateral partial foraminotomy was effective for preventing C5 palsy.
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There are both absolute and relative indications for the removal of pedicle screw fixation in the lumbar spine. Whatever the reasons are, removal of this hardware has required a surgical dissection that has been generally as extensive as the one used for their initial placement. These dissections are always disabling in the short term. In fact, the magnitude of this disabling pain can be significant enough so as to effectively eliminate screw removal as a logical treatment option for many conditions where indications for removal are only relative. Percutaneous pedicle screw fixation has served to amplify the stakes associated with this dilemma. In fact, this new technique makes the need for a less invasive method of pedicle screw removal greater now than ever. ⋯ Unlike most other minimal access surgical procedures, the learning curve for this procedure appears to be relatively flat. Removal of pedicle screw fixation in the manner described proved to be simple and straightforward. The benefits are dramatic and immediate. It is possible to complete the procedure within minutes, and the pain produced is best described as inconsequential. This minimally invasive technique radically alters both the intraoperative and postoperative courses for those who face pedicle screw removal. The disadvantages associated with the standard open approach are reduced to the production of mild short-term discomfort and an exposure to the potential risks of brief anesthesia and the possibility of a surgical infection. Considering that hospital stay should be limited to I day or less and that surgical times are less than I hour, minimally invasive removal or revision of hardware should reduce overall costs significantly.