European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Comparative Study
The use of surgical sealants in the repair of dural tears during non-instrumented spinal surgery.
To compare the success in repair of dural tears (DTs) using two different surgical sealants in non-instrumented lumbar spinal surgery and evaluate the incidence of associated short- and long-term complications. ⋯ Intraoperative DTs can be easily repaired by many effective techniques. However, in our experience, the use of BioGlue is an effective adjunct to immediate dural repair, being comparable in terms of efficacy and safety to the use of fibrin glue, potentially decreasing the incidence of associated short- and long-term complications.
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There is limited literature on the management of neglected healed (fused) bilateral cervical facet dislocation. The authors report a case of a middle aged male who developed a bilateral facet dislocation but only sought treatment 14 months post injury when he experienced pain and deformity in the cervical spine. ⋯ Current literature does not offer a clear solution to the management of healed neglected bilateral cervical facet dislocation. The presence of circumferential bony fusion around the deformity necessitates a posterior and anterior release and subsequent stabilization to address this complex problem. We also wish to highlight the order of the reconstructive approach and the need to recognize instability of the cervical spine despite normal CT scans in order to prevent late deformity.
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Observational Study
Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma.
Traumatic cervical spinal cord injuries (SCIs) frequently develop dural tears and resultant cerebrospinal fluid (CSF) leaks. They are not usually identified with advanced imaging, and there are no reports on managing CSF leaks after cervical trauma. Hence, the authors evaluated the incidence of CSF leaks after cervical SCIs and described how to predict and manage CSF leaks. ⋯ The incidence of CSF leaks after traumatic cervical SCI is relatively higher than that of degenerative cervical spinal surgery. An initial poor neurological status and disruption of the ligamentum flavum on the MRI in patients were predictable factors of dural tears and CSF leaks.
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Disorders in occipitocervical region are difficult to treat. Complications often occur after fusion surgery and may be life-threatening in severe cases. This study is to investigate the causes and treatment strategies for the postoperative complications of occipitocervical fusion. ⋯ The surgery of occipitocervical fusion carries a relative high risk for complications, especially if no instrumentation is used. The key points in reducing complications are the surgeon's familiarity with the anatomy of occipitocervical region and the appropriate internal fixation.
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To investigate the (1) radiographic and clinical accuracy of C1 anterior lateral mass screw (C1ALMS) and C2 anterior pedicle screw (C2APS) placement in the transoral atlantoaxial reduction plate (TARP)-III procedure, (2) screw insertion-associated clinical complications and (3) fusion status between C1 and C2. ⋯ C1ALMS placement in TARP-III procedures appears to be safe. The cortical breach rate of C2APS is high though clinically the neurovascular complication rate is similar to that of posterior atlantoaxial procedures. Advanced navigation strategies may help improve the accuracy of C2APS placement and decrease potential complications.