The spine journal : official journal of the North American Spine Society
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Present studies concerning the safety and reliability of neurophysiological monitoring during thoracic pedicle screw placement remain inconclusive, and therefore, universally validated threshold levels that confirm osseous breakage of the instrumented pedicles have not been properly established. ⋯ In the experimental animals, the observed electrical impedance depended on the distance of screws from the neural structures and not on the integrity of the pedicle cortex. The screw-triggered EMG technique did not reliably discriminate the presence or absence of bone integrity after pedicle screw placement. The response intensity was not related to the type of interposed tissue.
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Incidental durotomy during spine surgery is a common occurrence, with a reported incidence ranging from 3% to 16%. Risk factors identified by prior studies include age, type of procedure, revision surgery, ossification of the posterior longitudinal ligament, gender, osteoporosis, and arthritis. However, these studies are largely univariate analyses using retrospectively recorded data. ⋯ Revision surgery, age, lumbar surgery, degenerative disease, and elevated surgical invasiveness are significant risk factors for unintended durotomy during spine surgery. These data can be useful to surgeons and patients when considering surgical treatment.
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The anatomy of the atlantoaxial joint makes stabilization at this level challenging. Current techniques that use transarticular screw fixation (Magerl) or segmental screw fixation (Harms) give dramatically improved stability but risk damage to the vertebral artery. A novel integrated device was designed and developed to obtain intra-articular stabilization via primary interference fixation within the C1-C2 lateral mass articulation. ⋯ The integrated device resulted in interference fixation at the C1-C2 lateral mass joints with comparable stability to the Harms technique. Perceived advantages with the integrated device include avoidance of fixation below the C2 lateral mass where the vertebral artery is susceptible to injury, and access to the C1 screw entry point through the blade of the integrated device avoiding extended dissection superior to the C2 nerve root and its surrounding venous plexus.
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Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates. ⋯ Even after adjusting for patient demographics and comorbidity, we observed a large variation in reoperation rates across hospitals and surgeons after lumbar discectomy, a relatively simple spinal procedure. These findings suggest uncertainty about indications for repeat surgery, variations in perioperative care, or variations in quality of care.