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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Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have a detrimental effect on function and quality of life. The aim of this study was to measure changes in gait in people with CSM following surgical decompression. ⋯ These findings indicate that improvement in locomotor function can be achieved after surgery. Future studies should explore the potential for further recovery of gait through targeted neuro-rehabilitation.
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Case Reports
Major neurological deficit following anterior cervical decompression and fusion: what is the next step?
Major neurological deficit following anterior cervical decompression and fusion (ACDF) is a rare event, with incidences of up to 0.2 % now reported. Post-operative MRI is mandatory to assess for ongoing compression of the cord. In the past, the deficit has often been attributed to oedema or overzealous intra-operative manipulation of the cord. Reperfusion injury is a more recent concept. We describe a case of acute cervical disc prolapse with progressive neurology, and the difficult decision making one is faced with when the neurological deficit continues to deteriorate post ACDF. ⋯ The management of patients in whom a neurological deficit has increased post-operatively is difficult. Urgent MRI scan is mandatory to assess for epidural haematoma which may need further decompression. Cord reperfusion injury is a diagnosis of exclusion. The difficulty the clinician faces is in interpreting the MRI for 'acceptable' decompression, and therefore excluding the need for further surgery.
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The aim of this study was to investigate how the severity of operative invasion to the posterior muscular-ligament complex impacts postoperative cervical sagittal balance. ⋯ Open-door laminoplasty significantly affected postoperative cervical sagittal balance, with the cervical vertebra appearing to tilt forward. As the severity of surgical invasion to the posterior muscular-ligament complex increased, the loss of cervical sagittal balance also increased.
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Sagittal imbalance is a spine deformity with multifactorial etiology, associated with severe low back pain and gait disturbance that worsen deeply patients' quality of life. The amount of correction achievable through PSO is limited by the height of the resection of the posterior wall, causing a ceiling of segmental correction of 30-35°. The aim of this study is to describe and preliminarily evaluate the results of an alternative technique, corner osteotomy (CO), that can increase the amount of correction. ⋯ Corner osteotomy technique was more effective than the PSO in increasing segmental and lumbar lordosis with modest increase in blood loss and similar complication rate. The CO technique, in addition, proved a good reproducibility. Further studies with larger populations should confirm these preliminary results.