The spine journal : official journal of the North American Spine Society
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In obese patients, placing pedicle screws percutaneously is a particular challenge. As the bulky and thick configuration of obese patients may produce fuzzier fluoroscopic view and longer passage of surgical instruments, the chances of misplacement might increase. ⋯ Although symptomatic pedicle violations were noted in the earlier period of surgeon's learning curve and in overweight and obese patients, no statistical evidence could be found between patient's body habitus and percutaneous pedicle screw misplacement. Our data also suggest that greater caution should be exercised to avoid pedicle violations especially at L3 and L4.
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Few studies have analyzed the results of an interspinous distraction device in patients with lumbar spinal stenosis. It is still unknown whether the outcomes of an interspinous implant are related to the severity of stenosis. ⋯ The Aperius interspinous implant is poorly indicated for severe lumbar stenosis, which is significantly improved only in a small minority of cases, whereas decompression procedures ensure high chances of good results. The implant may be indicated for selected patients with moderate stenosis. The outcomes of the Aperius are not influenced by the type of clinical presentation of lumbar stenosis.
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Research on lumbosacral transitional vertebra (LSTV) has yielded important information on the structural alterations of the sacrum associated with LSTV. Nevertheless, very little data are available on the relationship of a given type of LSTV with either a typical pattern of sacral morphology or its gender distribution in the population. ⋯ Different lumbosacral transitions share a stronger, definite, and specific patterns of relationship with certain sacral morphologies and gender. It is important to recognize the nuances of these connections so as to understand low back pain conditions in the setting of a typical sacral articular morphology or the sex of the individual.
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Spring-back complication after open-door laminoplasty as described by Hirabayashi is a well-known risk, but its definition, incidence, and associated neurologic outcome remain unclear. ⋯ Spring-back closure occurred in 10% of our patients at or before 6 months after surgery. The incidence of spring-back by level (ie, 117 laminae) was 6%, mainly occurring at the lower cervical spine. All spring-back closures were partial segmental closures, most commonly involving C5 and C6. Postoperative neurologic deficit was associated with spring-back closure; therefore, surgeons should adopt preemptive surgical measures to prevent the occurrence of such a complication.
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Injuries to the thoracolumbar spine may lead to a complex array of clinical syndromes that result from dysfunction of the anterior motor units, lumbosacral nerve roots, and/or spinal cord. Neurologic dysfunction may manifest in the lower extremities as loss of fine and gross motor function, touch, pain, temperature, and proprioceptive and vibratory sense deficits. Two clinical syndromes sometimes associated with these injuries are conus medullaris syndrome (CMS) and cauda equina syndrome (CES). ⋯ After blunt trauma, these syndromes may reflect a continuum of dysfunction rather than a distinct clinical entity. The transitional anatomy at the thoracolumbar junction, where the conus medullaris is present, makes it less likely that a "pure" CMS or CES syndrome will occur and more likely that a "mixed" injury will. Surgical decompression is the mainstay of treatment for incomplete spinal cord injury (SCI) and incomplete CMS and CES. The value of timing of surgical intervention in the setting of incomplete SCI is unclear at this time. This review summarizes the recent information on epidemiology, pathophysiology, diagnosis, and controversies in the management of thoracolumbar neurologic injury syndromes.