Journal of neurosurgery. Spine
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The objective of this systematic review was to use evidence-based medicine to examine the efficacy of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM). ⋯ Treatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score
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In this special edition of Journal of Neurosurgery: Spine, a series of systematic reviews sponsored by the Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons/Congress of Neurological Surgeons is presented. This collection of comprehensive reviews summarizes the medical evidence related to the surgical management of cervical degenerative disc disease. Several of the key conclusions are discussed in this introduction to the issue: There is Class II evidence to suggest that the clinical condition remains stable when observed over a 3-year period in patients with mild-to-moderate cervical spondylotic myelopathy (CSM) and age younger than 75 years. ⋯ The use of BMP-2 is discouraged for anterior cervical spine surgery based on evidence suggesting that the risks outweigh any potential benefits. Finally, in patients with symptomatic cervical radiculopathy, arthroplasty achieves outcomes that are equivalent to anterior cervical decompression and fusion, although evidence for superiority is lacking. Further prospective longitudinal data are required to better define the role and timing of surgical intervention in CSM and to determine the appropriate use of cervical arthroplasty in the management of symptomatic cervical degenerative disc disease.
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The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). ⋯ Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.
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Radiographic and clinical evaluation of free-hand placement of C-2 pedicle screws. Clinical article.
Stabilization of the cervical spine can be challenging when instrumentation involves the axis. Fixation with C1-2 transarticular screws combined with posterior wiring and bone graft placement has yielded excellent fusion rates, but the technique is technically demanding and places the vertebral arteries (VAs) at risk. Placement of screws in the pars interarticularis of C-2 as described by Harms and Melcher has allowed rigid fixation with greater ease and theoretically decreases the risk to the VA. However, fluoroscopy is suggested to avoid penetration laterally, medially, and superiorly to avoid damage to the VA, spinal cord, and C1-2 joint, respectively. The authors describe how, after meticulous dissection of the C-2 pars interarticularis, such screws can be placed accurately and safely without the use of fluoroscopy. ⋯ Free-hand placement of screws in the C-2 pedicle can be done safely and effectively without the use of intraoperative fluoroscopy or navigation when the pars interarticularis/pedicle is assessed preoperatively with CT or MR imaging and found to be suitable for screw placement. When breaches do occur, they are overwhelmingly lateral in location, breach < 50% of the screw diameter, and in the authors' experience, are not clinically significant.
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Transpedicular instrumentation at C-7 has been well accepted, but salvage techniques are limited. Lamina screws have been shown to be a biomechanically sound salvage technique in the proximal thoracic spine, but have not been evaluated in the lower cervical spine. The following study evaluates the anatomical feasibility of lamina screws at C-7 as well as their bone-screw interface strength as a salvage technique. ⋯ These results suggest that using lamina screws as a salvage technique at C-7 provides similar fixation strength as the index pedicle screw. The C-7 lamina appears to have an ideal anatomical width for the insertion of 3.5-mm screws commonly used for cervical fusions. Therefore, if the transpedicular screw fails, using intralaminar screws appear to be a biomechanically sound salvage technique.