The spine journal : official journal of the North American Spine Society
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Case Reports
Anterior discectomy and total disc replacement for three patients with multiple recurrent lumbar disc herniations.
Although results of primary discectomy are generally excellent with relief of leg pain, recurrent lumbar disc herniation is relatively common ranging from 5% to 25%. Patients with recurrent herniation may undergo revision surgery; however, this carries with it increased risks and lower success rates. Many surgeons will advocate a fusion in addition to repeat discectomy after the third recurrent herniated disc. With the approval of lumbar total disc arthroplasty, there now exists another option for the patient with three or more recurrent disc herniations to preserve motion, theoretically decrease the rate of adjacent-level disease, and ameliorate the patient's symptoms. ⋯ Recurrent disc herniation is a relatively common problem that may be difficult to treat. Traditionally, a patient presenting with three or more recurrent disc herniation may likely have undergone revision discectomy with fusion. The current case report suggests that TDR may be an alternative option in select patients.
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Percutaneous vertebroplasty (PVP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). The complication rate of PVP is low, but cement leakage occurs in up to 90% of the treated levels. Recent evidence suggests that sequelae of cement leakage may be more common and clinically relevant than previously thought. Preoperative appreciation of risk factors would therefore be helpful but has not been thoroughly investigated. ⋯ High fracture severity grade and low viscosity of polymethylmethacrylate bone cement are general, strong, and independent risk factors for cement leakage. Using MRI assessment, cortical disruption and the presence of an intravertrebral cleft were identified as additional strong risk factors regarding cortical (intradiscal) cement leakage, thereby potentiating anticipation.
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Ambulation limitation is the hallmark of impairment in lumbar spinal stenosis (LSS). Capacity and performance have been defined as two distinct aspects of disability. Previous literature suggests that a person's walking capacity may not be reflected in their daily walking performance. ⋯ Walking capacity and walking performance in LSS appear to be different constructs. Survey instruments appear to reflect capacity rather than performance. This dissociation between walking capacity and walking performance has implications for the clinical management and outcomes assessment of people with LSS.
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Surgical indications for lumbar burst fracture remain controversial. Potential indications for surgery include 50% canal compromise, 50% loss of vertebral height, 30° of kyphosis, and posterior element fracture or disruption of the posterior ligamentous complex. Different surgical approaches are available depending on fracture characteristics. It is possible that a minimally invasive approach could allow for a safe and effective treatment with fewer comorbidities than the traditional open technique. ⋯ The traditional approach to an anterior lumbar corpectomy and posterior pedicle screw fixation involves significant postoperative pain and frequent ileus. This minimally invasive approach allowed for early mobilization, resumption of diet, and discharge from the hospital on postoperative day two.