The spine journal : official journal of the North American Spine Society
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Inadvertent perforation of the C0-C1 and C1-C2 joints is one of the potential complications of C1 screw insertion. ⋯ When the screw is directed between 0 degrees and 15 degrees medially, it can be inserted without C0-C1 and C1-C2 joint violation if the screw tip trajectory lies between the 20% and 40% points of the anterior atlas arch.
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Randomized Controlled Trial Multicenter Study
Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement.
Cervical total disc replacement (TDR) is an emerging technology. However, the factors that influence postoperative range of motion (ROM) and patient satisfaction are not fully understood. ⋯ Patients with greater disc collapse of less than 4mm preoperative disc height benefit more in ROM after TDR. The optimal postoperative disc height range to maximize ROM is between 5 and 7mm. This optimal range did not translate into better clinical outcome at 2-year follow-up.
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Interspinous process devices represent an emerging treatment for neurogenic intermittent claudication resulting from lumbar spinal stenosis. Most published descriptions of the operative technique involve treatment of patients in the modified lateral decubitus knee-chest position (modified lateral decubitus), and yet many surgeons have begun to perform the procedure in various prone positions. The patient's positioning on the operating room table seems likely to influence resting interspinous distance, and thus implant sizing and possibly the risk of intraoperative spinous process fracture. The intersegmental lumbar effect of variants on operative prone positioning compared with the modified lateral decubitus position has not been studied. ⋯ Prone positioning of patients in flexion on the operating table using the Andrews table or Wilson frame resulted in similar lumbar interspinous distance compared with the modified lateral decubitus position. Prone positioning on the Jackson frame resulted in statistically less interspinous distance than all other positions. Positioning on the Andrews table resulted in similar segmental angulation to the modified lateral decubitus position. Extrapolation from these data, obtained in healthy males younger than the typical age of patients treated with interspinous distraction devices, should clearly be done with caution. However, it seems reasonable to suggest that performing these procedures in the prone position using the Andrews table (greatest interspinous distance) is unlikely to result in the placement of significantly undersized implants, or significantly increase the force required to insert an implant.
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Osteoporosis and osteomalacia are significant risk factors for fracture and spine instrumentation failure. Low-energy fractures are becoming increasingly more common because of an increase in life expectancy and age of the population. Decreased bone density is an independent risk factor for instrumentation failure in spinal fusion operations. ⋯ Despite of the large number of elderly patients undergoing spine care and the high incidence of osteoporosis and/or osteomalacia in this population, a large portion of the spine surgeons who responded to the survey reported that they do not perform routine osteoporosis/osteomalacia workups. Of those who do perform workups, some commented that it will change their surgical plan or preoperative treatment. It appears that there is a need for increased awareness among spine specialists regarding osteoporosis screening and treatment. Osteoporosis practice patterns may also be affected with newly evolving government quality reporting regulations.
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Review Guideline
An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis.
The objective of the North American Spine Society (NASS) evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spondylolisthesis is to provide evidence-based recommendations on key clinical questions concerning the diagnosis and treatment of degenerative lumbar spondylolisthesis. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of January 2007. The goal of the guideline recommendations is to assist the practitioner in delivering optimum, efficacious treatment of and functional recovery from this common disorder. ⋯ A clinical guideline for degenerative lumbar spondylolisthesis has been created using the techniques of evidence-based medicine and using the best available evidence as a tool to aid practitioners involved with the care of this condition. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, is available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.