Journal of neurosurgery. Spine
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T2-weighted intramedullary increased signal intensity (ISI) on MRI in patients with cervical spondylotic myelopathy (CSM) appears to represent a wide spectrum of pathological changes that determine reversibility of cord damage. Although sharp T2-weighted ISI on preoperative imaging may correlate with poorer surgical outcomes, there are limited data on how these changes progress following surgery. In this study, the authors characterized pre-and postoperative ISI changes in patients undergoing surgery for CSM and studied their postoperative evolution in an attempt to quantify their clinical significance. ⋯ There is a distinct group of patients with multisegmental Type 3 intramedullary changes who show remarkable radiological regression after surgery but demonstrate a residual sharp focal ISI at follow-up. A regression of the ISI by > 50% predicts better functional outcomes. Patients with a good preoperative functional status remain the most likely to show improvement, and the improvement continues to occur even at remote follow-up. The clinical relevance of the quality of the T2-weighted ISI changes in patients with CSM remains uncertain; however, postoperative regression of the ISI change is possibly a more important correlate of patient outcome than the quality of the ISI change alone.
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Segmental instability in the lumbar spine can result from a number of mechanisms including intervertebral disc degeneration and facet joint degradation. Under traumatic circumstances, elevated loading may lead to mechanical yield of the annular fibers, which can decrease load-carrying capacity and contribute to instability. The purpose of this study was to quantify the biomechanics of intervertebral annular yield during tensile loading with respect to spinal level and anatomical region within the intervertebral disc. ⋯ Data in this study demonstrated that yielding of intervertebral disc fibers occurs relatively early in the mechanical response of the tissues and that stiffness is considerably decreased following yield. Therefore, yielding of annular fibers may result in decreased segmental stability, contributing to accelerated degeneration of bony components and possible idiopathic pain.
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Spinal stenosis with degenerative lumbar scoliosis (DLS) mostly occurs in the elderly population (typically > 65 years old), causing pain in the legs and back, claudication, and spinal deformity. The surgical strategy for DLS is controversial concerning the surgical approach, fusion area, decompression area, correction methods, and ideal angle of curve correction. A nonfusion stabilization system with motion preservation has been recently used for degenerative spinal diseases with favorable outcomes. This study attempted to analyze surgical outcomes after decompression and nonfusion stabilization for spinal stenosis with a mild to moderate degree of DLS. ⋯ Adding nonfusion stabilization after decompressive surgery resulted in a safe and effective procedure for elderly patients with lumbar stenosis with a mild to moderate scoliosis angle (< 30°). Statistically significant improvement of the clinical outcome was obtained at the last follow-up evaluation with no progression of the degenerative scoliosis.
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There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. ⋯ The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.