The spine journal : official journal of the North American Spine Society
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Anterior cervical discectomy and fusion (ACDF) is a very common operative intervention for the treatment of cervical spine degenerative disease in those who have failed non-operative measures. However, studies examining long-term follow-up on patients who underwent ACDF reveal evidence of radiographic and clinical degenerative disc disease at the levels adjacent to the fusion construct. Consistent with other junctional regions of the spine, the cervicothoracic junction (CTJ) has significant morphologic variations. As a result, the CTJ undergoes significant static and dynamic stress. Given these findings, there has been some thought that ACDF down to C7 may experience additional risks for adjacent segment degeneration/disease (ASD) when compared with ASDFs that are cephalad to C7. ⋯ The cervicothoracic junction may present with vulnerability to ASD given the junctional biomechanics. However, this study provides evidence that an ACDF with the caudal level of C7 does not incur additional risk of ASD, showing similar outcomes to ACDFs at other levels.
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Open door laminoplasty (ODLP) can also lead to significant postoperative motion restriction that further increases over time, for which one of the possible factors is the bony impingement between neighboring posterior bony arches. Previously, we reported this phenomenon and modified technique of ODLP, wedge-shaped resection of the posterior bony arch that produced greater range of motion (ROM) of the cervical spine and less posterior neck pain compared with conventional ODLP (cODLP) in 1-year follow-up time, but no longer follow-up outcomes of the surgical technique has been reported. ⋯ These results indicate that posterior bony impingement can be a factor in ROM restriction after cODLP surgery and that wedge-shaped resection during ODLP can be a reliable option for preserving cervical ROM and improving postoperative clinical and radiological outcomes.
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Review Comparative Study
Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates.
Severe adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1%, and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement, whereas image guidance has been suggested to improve placement accuracy. ⋯ Although point estimates on breach rates are decreased with CT navigation compared with free-hand methods, complication rates remain conflicting between the two methods. Current evidence is limited by small sample sizes, lack of comparison groups, and poorly predefined complications. Randomized controlled trials with larger samples with standardized definitions and recording of predefined breach and complication occurrences are recommended.
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Comparative Study
The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study.
Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery. ⋯ We described the feasibility of using a novel cadaveric model for both the study and training of watertight dural closure techniques. 6-0 Prolene was observed to be superior to 4-0 Nurolon for watertight dural closure without a hydrogel sealant. The use of a hydrogel sealant significantly improved watertight dural closures for both 6-0 Prolene and 4-0 Nurolon groups in the cadaveric model.
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Heterogeneity exists within the low back pain (LBP) population. Some patients recover after every pain episode, whereas others suffer daily from LBP complaints. Until now, studies rarely make a distinction between recurrent low back pain (RLBP) and chronic low back pain (CLBP), although both are characterized by a different clinical picture. Clinical experiences also indicate that heterogeneity exists within the CLBP population. Muscle degeneration, like atrophy, fat infiltration, alterations in muscle fiber type, and altered muscle activity, compromises proper biomechanics and motion of the spinal units in LBP patients. The amount of alterations in muscle structure and muscle function of the paraspinal muscles might be related to the recurrence or chronicity of LBP. ⋯ These results indicate a higher amount of fat infiltration in the lumbar muscles, in the absence of clear atrophy, in continuous CLBP compared with RLBP. A lower metabolic activity of the lumbar muscles was seen in RLBP replicating a relative lower intensity in contractions performed by the lumbar muscles in RLBP compared with non-continuous and continuous CLBP. In conclusion, RLBP differs from continuous CLBP for both muscle structure and muscle function, whereas non-continuous CLBP seems comparable with RLBP for lumbar muscle structure and with continuous CLBP for lumbar muscle function. These results underline the differences in muscle structure and muscle function between different LBP populations.