The spine journal : official journal of the North American Spine Society
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Comparative Study
Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft.
The use of metal cage prosthetic devices in anterior cervical discectomy with fusion (ACDF) has increased rapidly. One of these devices is the titanium Rabea cage (Signus, Alzenau, Germany) [correction]. There are no peer-reviewed objective reports on the use of these cages in cervical discectomy. ⋯ This is the first prospective, independently conducted report on Rabea cages. Results of the short-term (6 months) follow-up did not differ from outcomes results in our patients who have undergone ACDF with bone allograft. Although this is a preliminary assessment, the Rabea cage may represent an alternative to bone dowels and hip graft. As is the case for other allografts, artificial or bone, the main advantage is elimination of donor site complications, and the disadvantages include difficulty in radiographic assessment of fusion and potential for cage subsidence.
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Coccydynia is a painful condition of the terminal portion of the spine often resulting from direct trauma, childbirth or unknown etiology. This is a relatively rare condition with no universally accepted treatment protocol. ⋯ Patients with coccydynia should be managed conservatively when possible. Treatment should include NSAIDs and local steroid injections. Patients will often require repeat injections over time. Surgery can offer reasonable results for patients failing conservative treatment, but they should be warned of the high rate of infection.
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Comparative Study
Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures.
Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. ⋯ Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively.
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Pain anticipated before and induced by physical activities has been shown to influence the physical performance of patients with chronic back pain. Limited data exist as to the influence of treatment on this component of pain. ⋯ Anticipated and induced pain with physical activities was lessened after physical therapy using exercise. Anticipated and induced pain with physical activities related to physical performance levels, global pain and disability ratings. These findings may help explain how exercise exerts a positive influence on chronic back pain and disability.
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Spinal surgery carries risks of incidental spinal cord and nerve root injury. Neuroprotection, to minimize the extent of such injuries, is desirable. However, no neuroprotective strategies have been conclusively validated in nonvascular spinal surgery. Mild hypothermia resulting from general anesthesia is a readily achievable potential neuroprotective strategy. Mild hypothermia, however, has been associated with wound infection, increased operative blood loss and other complications. No previous studies have specifically evaluated whether mild hypothermia is associated with an increased risk of these complications in elective spinal surgery. ⋯ Operative blood loss was not linked to any index of the patient's temperature. Longer anesthesia durations were linked to complications and increased blood loss. Regarding mild hypothermia, neither mean nor nadir hypothermic temperatures were linked to complications, but the estimated total quantity of subbaseline temperature was linked, as was total fluctuation in temperature. Lengthy exposure to mild hypothermia appeared to be associated with wound infections. The use of mild hypothermia as a potential neuroprotective strategy during spinal surgery appears to be reasonably safe, but to avoid complications, the duration of hypothermic exposure should be minimized.