Acta neurochirurgica
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Acta neurochirurgica · Jul 2011
Review"Minimally invasive" lumbar spine surgery: a critical review.
Minimal-access technology has evolved rapidly with "tubular" or "percutaneous" approaches for decompression and stabilization in the lumbar spine. Potential benefits (smaller scars, diminished local pain, reduced blood loss, reduced postoperative wound pain, shorter hospital stays) have to be weighed against possible drawbacks (reduced orientation, steep learning curve, increased radiation exposure, dependency on technology, cost). While non-comparative case series are often rather enthusiastic, comparative studies and particularly RCTs are scarce and might convey a more realistic appreciation. ⋯ This review, based solely on the very limited number of available comparative studies, shows no relevant benefit from minimally invasive techniques, and a tendency for more safety in open procedures in lumbar disc herniation, TLIF and PLIF.
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Acta neurochirurgica · Jul 2011
Clinical TrialAccuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability.
The C1 lateral mass and C2 isthmic stabilization, as introduced by Goel and Laheri and by Harms and Melcher, is a well-known fixation technique. We present the clinical and radiographic results with freehand fluoroscopy guided C1 lateral mass and C2 isthmic fixation in a consecutive series of 28 patients, evaluating the accuracy of screw placement. ⋯ Freehand fluoroscopy-guided insertion of C1 lateral mass and C2 isthmic screws can be safely and effectively performed.
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Acta neurochirurgica · Jul 2011
Long-term clinical and radiological outcomes following stand-alone PLIF surgery using expandable cylindrical threaded cages in patients with degenerative lumbar spine disease.
Although posterior lumbar interbody fusion (PLIF) using stand-alone cages was a popular arthrodesis method, the effectiveness of using such cages has been questioned. We assessed retrospectively the long-term clinical and radiological outcomes of PLIF surgery using stand-alone cages for the treatment of degenerative lumbar spine disease, the incidences of pseudoarthrosis, and its risk factors. ⋯ The use of PLIF with stand-alone threaded cages in degenerative lumbar disease patients resulted in a long-term clinical success rate of 74.4%. Although the radiological fusion rate was 85.2%, continuous reduction of disc height and poor alignment preservation were observed. We conclude, therefore, that PLIF using only stand-alone cages is a poor surgical option for achieving good alignment and disc height restoration in patients with degenerative lumbar disease.
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Acta neurochirurgica · Jun 2011
Quantitative parameters of facial motor evoked potential during vestibular schwannoma surgery predict postoperative facial nerve function.
Facial motor evoked potential (FMEP) amplitude ratio reduction at the end of the surgery has been identified as a good predictor for postoperative facial nerve outcome. We sought to investigate variations in FMEP amplitude and waveform morphology during vestibular schwannoma (VS) resection and to correlate these measures with postoperative facial function immediately after surgery and at the last follow-up. ⋯ FMEP amplitude ratio and waveform morphology during VS resection seem to represent independent quantitative parameters that can be used to predict postoperative facial function. Event-to-baseline FMEP monitoring is quite useful to dictate when intraoperative changes in surgical strategy are warranted to reduce the chances of facial nerve injury.