The spine journal : official journal of the North American Spine Society
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Anterior decompression and fusion (ADF) for ossification of the posterior longitudinal ligament (OPLL) is technically demanding and associated with complications. Although various factors affecting clinical outcome have been investigated in posterior decompression, prognostic factors of ADF remain unclear. ⋯ Anterior decompression and fusion has favorable outcome in patients with an occupying ratio ≥60% or with presence of ISI on MRI. Presence of higher ISI grade, higher occupying ratio, and older age were associated with a poor long-term surgical prognosis. Therefore, evaluating ISI and occupying ratio on preoperative MRI is important for selecting the appropriate surgical approach and for predicting clinical outcome after surgery for cervical compressive myelopathy due to OPLL.
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Revision surgery for pseudarthrosis after a lumbar spinal fusion has unpredictable functional results. ⋯ The clinical outcomes after revision surgery for pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
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A frequently quoted advantage of anterior lumbar interbody fusion (ALIF) is indirect foraminal decompression, although there are few studies substantiating this statement. Also, there are no clinical studies using a standardized method to measure the foraminal area (FA) and the correlation with disc height (DH) parameters. This study is proposed to measure the degree of indirect foraminal decompression radiologically using a standardized method and correlate with the intervertebral disc parameters. ⋯ Anterior lumbar interbody fusion results in significant indirect foraminal decompression based on the new P-P technique. Posterior DH is a significant factor in the restoration of the FH.
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The incidence of metastatic spinal cord compression (MSCC) is increasing, paralleling increasing life expectancy of patients. However, management of MSCC and relevance of scoring systems remain controversial. ⋯ Surgery for MSCC is associated with limited morbidity, improved autonomy, and pain relief. Usual scores do not seem relevant, whereas ASA score, KPS, and extrabone metastases are significantly associated with OS.
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Allogeneic blood transfusions have an immunomodulating effect, and the previous studies in other fields of medicine demonstrated an increased risk of infections after administration of allogeneic blood transfusions. ⋯ Conscious of the limitations of this retrospective study, our data suggest an increased risk of surgical site infection, urinary tract infection, and overall postoperative infections, but not pneumonia, after exposure to allogeneic blood transfusion in patients undergoing lumbar spine surgery. These findings should be taken into account when considering blood transfusion and developing transfusion policies for patients undergoing lumbar spine procedures.