The spine journal : official journal of the North American Spine Society
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It is unknown whether direct repair (DR) of pars defect after lumbar discectomy (LD) for patients with lumbar disc herniation (LDH) and spondylolysis leads to better outcomes than LD alone. ⋯ At the 1-year follow-up, DR after LD was associated with better outcomes for LDH with spondylolysis than LD alone.
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The classic surgical treatment of spinal stenosis involves bilateral dissection of paraspinal muscles to expose all the involved levels, wide laminectomy, and medial facetectomy and foraminotomy. The surgical morbidity of the procedure is further magnified by being more common in elderly with associated medical comorbidities and being usually global involving multiple levels. To address this problem, several less invasive techniques have been introduced over the past decade including the microendoscopic decompression. ⋯ Irrigation endoscopic decompressive laminotomy allows the surgeon to safely perform effective central and foraminal decompression resulting in satisfactory midterm clinical results. Substituting long surgical incisions with 0.5-cm stabs and direct placement of instruments without dissection or dilatation could result in an improved postoperative course, shortened time for hospitalization, and reduced infection rate. However, still multicenter studies and randomized trials are needed before making final conclusions.
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The options available for treatment of Irreducible Atlantoaxial Dislocation (IAAD) with basilar invagination are odontoidectomy, posterior decompression, posterior atlanto-axial joint distraction. In 2006 Wang et al described that most IAAD can be reduced following anterior release of contracted soft tissues. Anterior release may be done by transoral (TO) or retropharyngeal (RP) approach. Posterior instrumented fusion provides stability and helps in achieving further reduction. ⋯ This series reinforces the safety and efficacy of both trans-oral and retro-pharyngeal anterior release for reduction of Irreducible AAD. Posterior fixation helps in achieving further reduction and provides stability. Anterior release followed by instrumented posterior fusion is a safe and effective modality of treatment for irreducible AAD associated with basilar invagination.