Journal of neurosurgery. Spine
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This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc. ⋯ In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.
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Posttraumatic syringomyelia produces a significant burden of pain and neurological deficits in patients with spinal cord injury. The mechanism of syrinx formation is unknown and treatment is often ineffective. A possible explanation for syrinx formation is fluid leakage from the microcirculation in the presence of a compromised blood-spinal cord barrier (BSCB). The aim of this study was to investigate the structural and functional integrity of the BSCB in a model of posttraumatic syringomyelia. ⋯ This study demonstrated a prolonged structural and functional disruption of the BSCB in this model of posttraumatic syringomyelia. Loss of functional integrity of the BSCB, with fluid entering the interstitial space of the spinal cord, may contribute to initial cyst formation after spinal cord injury and subsequent enlargement of the cyst, to produce posttraumatic syringomyelia.
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The pedicle screw has been reported to provide the strongest fixation for the cervical spine, but there is a possibility of malpositioning the screws, which may cause fatal complications such as vertebral artery and neural injuries. Using the conventional freehand technique, between 6.7 and 29% of the screws have been found to be malpositioned. If an accurate entry point and insertion trajectory through the isthmus of the pedicle can be maintained during surgery, safer insertion of the pedicle screw should be achieved. The authors have developed a new pedicle screw insertion method, called the "CT cutout" technique, and report on the technical and clinical aspects of this new technique in terms of accuracy. ⋯ Several techniques for pedicle screw insertion such as computer-assisted navigation, CT-based navigation, and acquisition of fluoroscopic intraoperative pedicle axis views have been used for improving accuracy. However, there remains a possibility of misplacement, and these costly procedures often require delivery of a high x-ray dose to both patients and surgeons, and/or time-consuming configuration of reference points during surgery. The CT cutout technique is an easy, low-cost procedure that can be performed with the aid of single-plane fluoroscopy and without the need of configuration. This new technique shows great promise for safe pedicle screw insertion for the cervical spine.