Journal of neurosurgery. Spine
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Cervical pedicle screw (PS) misplacement leads to injury of the spinal cord, nerve root, and vertebral artery. Recently, several investigators reported on the usefulness of a spinal navigation system that improves the accuracy of PS insertion. In this study, the authors assessed the accuracy of cervical pedicle, lateral mass, and odontoid screw insertions placed using a 3D fluoroscopy navigation system, the Iso-C3D unit. ⋯ In this study, the authors were able to correctly insert cervical PSs using the 3D fluoroscopy and navigation system.
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The occipital condyle has never been studied as a viable structure that could permit bone purchase by fixation devices for occipitocervical fusion. The authors propose occipital condyle screw placement as a possible alternative to conventional occipitocervical fixation techniques. ⋯ Occipital condyle screw placement is a safe and viable option for occipitocervical fixation and could be a preferred procedure in selected cases. However, further biomechanical studies are required to compare its reliability to other more established techniques.
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Beside several other advantages, the transforaminal approach for lumbar interbody fusion offers the possibility of reducing surgical trauma by limiting the approach to only 1 side. This requires posterior stabilization methods, which are applied without the need to damage contralateral muscles and soft tissues. The goal in this study was to compare different posterior stabilization methods for minimally invasive transforaminal lumbar interbody fusion (TLIF) biomechanically. ⋯ Bilateral PS augmentation offers significantly more stability than unilateral PSs in the majority of the test modes. There was no significant difference between the other tested methods. All tested stabilization methods could achieve at least the stability of the native segment.
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Spinal surgery-associated rhabdomyolysis, although rare, is a life-threatening condition. Presented here is the case of a middle-aged, overweight man who underwent posterior lumbar surgery because of pain and neurogenic claudication. His postoperative course was complicated by the occurrence of rhabdomyolysis. ⋯ His condition was grave enough to require the administration of intermittent hemodialysis. After a prolonged hospitalization and 5 sessions of hemodialysis, the patient achieved a full recovery. In view of the fact that rhabdomyolysis-induced acute renal failure is associated with a mortality rate of 20-50%, the outcome was favorable.
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The most contentious issue in the management of os odontoideum surrounds the decision to attempt atlantoaxial fusion in patients with asymptomatic lesions. The authors examined the clinical presentation and outcome in patients with os odontoideum who underwent surgical stabilization, with an emphasis on 3 patients who initially received conservative treatment and suffered delayed neurological injury. ⋯ The authors believe that patients with os odontoideum are at risk for future spinal cord compromise. Forty-four percent of our patients had myelopathic symptoms at referral, and 3 had significant neurological deterioration when a known os odontoideum was left untreated. This risk of late neurological deterioration should be considered when counseling patients. Stabilization using internal screw fixation techniques resulted in 100% fusion, whereas 15% of patients had previously undergone unsuccessful wire and external bracing attempts.