The spine journal : official journal of the North American Spine Society
-
Lumbar fusion is traditionally used to restore stability after wide surgical decompression for spinal stenosis. The Total Facet Arthroplasty System (TFAS) is a motion-restoring implant suggested as an alternative to rigid fixation after complete facetectomy. ⋯ TFAS restored range and quality of motion at the operated segment to intact values and restored near-normal motion at the adjacent segments.
-
Case Reports
Traumatic spondyloptosis resulting from high-energy trauma concurrent with a tonic-clonic seizure.
Traumatic lumbosacral dislocation injuries are rare, high-energy injuries that are challenging to surgically manage. ⋯ The injury pattern described is quite rare. This case of multilevel, bilateral pedicle fracture with traumatic L5-S1 spondyloptosis was successfully treated by circumferential reduction and arthrodesis without neurological injury.
-
One of the primary difficulties in evaluating the effectiveness of lumbar fusion is that, with the exception of spondylolisthesis, specific diagnostic indications for surgery are poorly defined. Diagnostic specificity beyond the symptom of low back pain or the presence of lumbar degeneration needs to be delineated such that outcomes data can be effectively translated into clinical decision making or evidence-based guidelines. ⋯ This study supports the concept that added diagnostic specificity is a critical component in building an improved evidence base for lumbar fusion surgery. The magnitude of HRQOL improvement was not equal among diagnostic subgroups. The percentage of patients reaching an MCID level of improvement was also significantly influenced by diagnostic stratification. Without diagnostic specificity for entities beyond spondylolisthesis, the absence of well-defined study populations will continue to limit our ability to move toward evidence-based decision making.
-
Ewing's sarcoma is the most common childhood malignancy of bone, but it rarely occurs as a primary extraosseous epidural tumor. ⋯ Ewing's sarcoma of the epidural space should be considered in the differential diagnosis of epidural mass lesions. Because wide surgical margins cannot be obtained, close follow-up with a low threshold for reoperation is mandatory.