Neurosurgery
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Arthrodesis is optimized when the structural graft occupies most of the surface area within a disc space. The transforaminal corridor inherently limits interbody size. ⋯ Inserting a second interbody using a transforaminal approach is anatomically feasible and nearly doubles the disc space covered without affecting ROM. Compressive stiffness significantly increased with 2 nested interbodies, and foraminal height increased. Evaluation of the clinical safety and efficacy of nested interbodies is underway.
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Adjacent segment disease (ASD) has not been described after laminectomy without fusion. ⋯ The cumulative incidence of ASD requiring reoperation was 10% over a mean of 4 years. Both the 1- and 2-level laminectomy cohorts experienced equivalent incidences and rates of ASD. Of the 39 operations for ASD, about half required a fusion.