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Traumatic Lateral Spondyloptosis: Case Series.

OBJECTIVE: To apprise readers about this rare but severest form of traumatic spine injury and its surgical management. BACKGROUND: Complete fracture dislocation and subluxation (>100%) of 1 vertebral body in the coronal or sagittal plane with respect to the adjacent vertebra is defined as spondyloptosis. In coronal spondyloptosis the subluxated vertebral bodies lie beside each other, and the condition is lateraloptosis. Patients with lateraloptosis present unique surgical challenges because reduction and achieving realignment of spinal column require meticulous planning and execution. METHOD

Learning Curve of Minimally Invasive Surgery Oblique Lumbar Interbody Fusion for Degenerative Lumbar Diseases.

OBJECTIVE: To characterize the learning curve for a single surgeon during his initial phases of performing minimally invasive surgery oblique lumbar interbody fusion. METHODS: This was a prospective analysis of 49 consecutive patients who underwent a single-level minimally invasive surgery oblique lumbar interbody fusion performed by a single surgeon. Patients were divided into group A (first 24 patients) and group B (25 patients after initial 24 patients). The following data were compared between the 2 groups: surgical time, estimated blood loss, radiograph exposure time, clinical and radiog

Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion.

OBJECTIVE Over the past decade, Enhancing Recovery After Surgery (ERAS) programs have been implemented throughout the world across multiple surgical disciplines. However, to date no spinal surgery equivalent has been described. In this report the authors review the development and implementation of a "fast track" surgical approach for lumbar fusion. METHODS The first 42 consecutive cases in which patients were treated with the new surgical procedure were reviewed. A combination of endoscopic decompression, expandable cage deployment, and percutaneous screw placement were performed with liposom

Surgical results of lumbar interbody fusion using calcium phosphate cement.

Clinical and radiological outcomes of lumbar interbody fusion using artificial fusion cages filled with calcium phosphate cements (CPCs) were retrospectively reviewed. Between 2002 and 2011, 25 patients underwent lumbar interbody fusion at Tokushima University Hospital, and 22 patients were enrolled in this study. Of these, 5 patients received autologous local bone grafts and 17 received CPC. Japan Orthopedic Association (JOA) score was used for clinical outcome assessments. Lumbar radiography and computed tomography (CT) were performed at 12, 24 months and last follow-up period to assess bony

Validity of creatine kinase as an indicator of muscle injury in spine surgery and its relation with postoperative pain.

PURPOSE: To confirm the validity of postoperative creatine kinase (CK) values as an indicator of muscle lesion, assess the relationship of CK with variables indicating surgical invasiveness and investigate an association between CK values and excessive postoperative pain. MATERIAL AND METHODS: The study included 96 patients (mean age 62.8 years) who underwent instrumented spine fusion for degenerative lumbosacral disease. Serum CK concentration was determined on the first postoperative day. All patients received intravenous paracetamol and metamizole, and in cases of intense pain, rescue anal

The role of the vascular surgeon in anterior lumbar spine surgery.

OBJECTIVES: Advances in spinal fusion techniques have led to an increase in the need for safe access to the lumbar spine anteriorly. The aim of this study is to examine the procedure-related complications of anterior lumbar inter-body fusion (ALIF) or anterior lumbar disc replacement (ALDR) when performed jointly by a vascular-surgeon and a neurosurgeon in a single centre. METHODS: A retrospective cohort analysis was conducted for all patients who underwent ALIF or ALDR between 2004 and 2010. Operative notes were examined to identify any procedure-specific complications. In-hospital postopera

Perioperative complications and adverse events after lumbar spinal surgery: evaluation of 1012 operations at a single center.

BACKGROUND: Lumbar surgery and associated complications are increasing as society is aging. However, definitions of complications after lumbar surgery have not been established and previous reports have varied in the definition of, and focus on, intraoperative or major postoperative complications. We analyzed the frequency and severity of perioperative complications and all minor adverse events in lumbar surgery at a single center. METHODS: We retrospectively reviewed all lumbar surgery, including decompression surgery with or without fusion, at Meijo Hospital over a 10-year period. Periopera

The unique characteristics of "upper" lumbar disc herniations.

OBJECTIVE: To compare the characteristics, presentation, and surgical outcome of patients with microdiscectomies at L1-L2 and L2-L3 with those we treated at L3-L4. We further sought to compare these results with those reported in the literature for discectomies at the L4-L5 and L5-S1 levels. METHODS: We reviewed the clinical data collected from 69 patients who had 72 L1-L2, L2-L3, and L3-L4 microdiscectomies performed from 1989 to 1999 at the New York University Medical Center. Patients who had surgery at L1-L2 or L2-L3 were grouped and compared with those treated at the L3-L4 level. Patients

Titanium mesh cages (TMC) in spine surgery.

The introduction of the titanium mesh cage (TMC) in spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. Differing applications of TMCs in the whole spine are described in a series of 150 patients. Replacement and reinforcement of the anterior column represent the classic use of cylindrical TMCs. The TMC as a multisegmental concave support in kyphotic deformities and as a posterior interlaminar spacer or lamina replacement after wide laminectomy are additional applications. Implant subsidence, pseudarthrosis and implant loose

Single versus separate registration for computer-assisted lumbar pedicle screw placement.

STUDY DESIGN: This is a retrospective study conducted to evaluate the efficacy of single versus separate registration in assessing the pedicle screw accuracy in the computer-assisted lumbar spinal instrumentation. OBJECTIVES: To see if separate registration reduced lumbar pedicle screw misplacement. SUMMARY OF BACKGROUND DATA: Computer-assisted spinal instrumentation has been shown to improve pedicle screw installation accuracy, but 2.7% to 8% of screws still perforate the pedicular cortex. Suspected causes include differences in lumbar lordosis between preoperative CT scans and surgery. ME

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… Methods: The sample size was twenty patients who underwent lumbar spine surgery for symptomatic disc herniation or spondylolisthesis. Intervertebral discs were classified by magnetic resonance as Pfirrmann grade IV and grade V. …

Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis.

BACKGROUND: The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusio … o statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 …

Risk factors and clinical significance of posterior slip of the proximal vertebral body after lower lumbar fusion.

BACKGROUND: Adjacent segment disease (ASD) after fusion surgery is frequently manifests as a cranial segment instability, disc herniation, spinal canal stenosis, spondylolisthesis or retrolisthesis. The risk factors and mechanisms of ASD have been widely discussed but never clearly defined. AIM: To investigate the risk factors and clinical significance of retrograde movement of the proximal vertebral body after lower lumbar fusion. METHODS: This was a retrospective analysis of the clinical data of patients who underwent transforaminal lumbar interbody fusion surgery between September 2015 an…

Do patients with lumbar spinal stenosis benefit from decompression of levels with adjacent moderate stenosis? A prospective cohort study from the NORDSTEN study.

BACKGROUND: Lumbar spinal stenosis (LSS) is characterized by pain that radiates to the buttocks and/or legs, aggravated by walking and relie … clinical outcomes of three different surgical treatment options for LSS. Patients with degenerative spondylolisthesis were excluded. METHOD: Based on preoperative MRI, the present analysis included all patients who had a moderate stenosis (defined as Schizas B or C) in addition to a predefined index stenosis (the level with the smallest cross-sectional area). We c …

Bilateral paraspinal muscle flap closure technique for reduction of wound complications from posterior thoracolumbar spinal fusion: results of a series of 716 patients.

OBJECTIVE: Wound complications such as surgical site infection (SSI) and dehiscence are among the most common complications of thoracolumbar … ) and 32 (7%) patients; trauma in 10 (4%) and 14 (3%) patients; and degenerative disease, including spondylolisthesis, spondylolysis, and stenosis, in 207 (79%) and 409 (90%) patients, with more muscle flap patients having metastasis (p < 0.00001). Patients having muscle flaps had significantly higher rates of diabetes, smoking, and revision surgery, and a higher m …

Evaluation of Decompression and Interlaminar Stabilization Compared with Decompression and Fusion for the Treatment of Lumbar Spinal Stenosis: 5-year Follow-up of a Prospective, Randomized, Controlled Trial.

INTRODUCTION: If nonoperative treatment for lumbar stenosis fails, surgery may be considered. This traditionally includes decompression ofte … Patients with moderate to severe lumbar stenosis at one or two contiguous levels and up to Grade I spondylolisthesis were randomized (2:1 ratio) to decompression and interlaminar stabilization (D+ILS; n=215) using the coflex(®) Interlaminar Stabilization(®) device (Paradigm Spine, LLC) or decompression and fusion with pedicle screws (D+PS; n=107). Clinical evaluat …

Do lumbar motion preserving devices reduce the risk of adjacent segment pathology compared with fusion surgery? A systematic review.

STUDY DESIGN: A systematic review of the literature. OBJECTIVE: To compare total disc replacement (TDR) with fusion, other motion-sparing d … atients who had degenerative disc disease, disc herniation, radiculopathy, kyphosis, scoliosis, and spondylolisthesis, and who were treated with TDR, other motion-sparing procedures, or fusion. The overall strength of the evidence for each key question was rated using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. RESULTS: Th …

Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion.

OBJECT: Cervical stenotic myelopathy due to spondylosis or ossification of the posterior longitudinal ligament is often treated with laminoplasty or cervical laminectomy (with fusion). The goal of this study was to compare outcomes, radiographic results, complications, and implant costs associated with these 2 treatments. METHODS: The authors analyzed the records of 56 patients (age range 42–81 years) who were surgically treated for cervical stenosis. Of this group, 30 underwent laminoplasty and 26 underwent laminectomy with fusion. Patients who had cervical kyphosis or spondylolisthesis were…