The spine journal : official journal of the North American Spine Society
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Follow-up studies of patients undergoing anterior cervical discectomy and interbody fusion (ACDF) have demonstrated varying degrees of radiographic degeneration at adjacent levels, with most cases being asymptomatic (adjacent segment degeneration, ASDeg) and far fewer being symptomatic (adjacent segment disease, ASDz). Controversy remains as to whether these conditions are related to altered biomechanics or represent the natural history of cervical spondylosis at the adjacent segment. ⋯ This review highlights the heterogeneous methodology of the peer-reviewed literature on ASDeg and ASDz after ACDF and the paucity of high-level clinical data published on these conditions. Despite the low level of evidence to define the incidence of ASDeg and ASDz, it is clear that radiographic ASDeg is more common than symptomatic ASDz, indicating that adjacent segment pathology remains subclinical in a large subset of patients. This analysis underscores the need for standardized radiographic measures in the assessment of ASDeg and validated clinical outcome measures for ASDz after ACDF. Consistent methodology and multi-surgeon collaboration may improve the quality of clinical data on ASDeg and ASDz and elucidate the true etiology and incidence of these conditions.
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Randomized Controlled Trial
Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?
Surgical reduction and posterior lumbar interbody fusion (PLIF) is commonly used to recover segmental imbalance in degenerative spondylolisthesis. However, whether intentional reduction of the slipped vertebra during PLIF is essential in aged patients with degenerative spondylolisthesis remains controversial. ⋯ Posterior lumbar interbody fusion with pedicle screws fixation, with or without intraoperative reduction, provides good outcomes in the surgical treatment of aged patients with degenerative spondylolisthesis. Better radiological outcomes by intentional reduction do not necessarily indicate better clinical outcomes.
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In the instrumented fusion, adjacent segment facet joint violation or impingement by pedicle screws is unavoidable especially in cephalad segment, despite taking specific intraoperative precautions in terms of surgical approach. In such circumstances, unlike its original purpose, unilateral pedicle screw instrumentation can contribute to reduce the degeneration of cephalad adjacent segment by preventing contralateral cephalad adjacent facet joint from the unavoidable injury by pedicle screw insertion. However, to our knowledge, no long-term follow-up study has compared adjacent segment degeneration (ASD) between unilateral and bilateral pedicle screw instrumented fusion. ⋯ In a minimum 10-year follow-up retrospective study of posterolateral fusion for lumbar spinal stenosis and/or Grade 1 spondylolisthesis, unilateral pedicle screw instrumentation showed a lower rate of radiologic ASD, especially in second cephalad adjacent segment, and a better clinical outcome by ODI.
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Case Reports
Postoperative spinal cord herniation with pseudomeningocele in the cervical spine: a case report.
Postoperative spinal cord herniation with pseudomeningocele is a rare disease, with only five cases reported before the present study. ⋯ The release of adhesion around dural defect and repair of dural defect under spinal cord monitoring resulted in a satisfactory neurologic recovery. Surgical repair of the dural defect with a dural substitute was necessary.
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Lumbar spinal stenosis is one of the most common degenerative spine diseases. Surgical options are largely divided into decompression only and decompression with arthrodesis. Recent randomized trials showed that surgery was more effective than nonoperative treatment for carefully selected patients with lumbar stenosis. However, some patients require reoperation because of complications, failure of bony fusion, persistent pain, or progressive degenerative changes, such as adjacent segment disease. In a previous population-based study, the 10-year reoperation rate was 17%, and fusion surgery was performed in 10% of patients. Recently, the lumbar fusion surgery rate has doubled, and a substantial portion of the reoperations are associated with a fusion procedure. With the change in surgical trends, the longitudinal surgical outcomes of these trends need to be reevaluated. ⋯ The reoperation rate was not different between decompression and fusion surgeries. With current surgical trends, the reoperation rate appeared to be higher than in the past, and consideration of this problem is required.