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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The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients' functional ability. ⋯ PSO is a valuable surgical procedure in correction of severe hypolordosis (=relative kyphosis) in the lumbar spine. It is a demanding procedure for the surgeon, the anesthesiologist and the intensive care team. Although its complication rate is high, it has a substantial positive impact in the quality of life of patients, including the elderly.
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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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We aimed to identify technique-related factors influencing radiographic and patient-rated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF). ⋯ Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO.
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Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder in the elderly. Diffusion tensor imaging (DTI) has been shown to be of great value for evaluating the microstructure of nerve tracts in the spinal cord. Currently, the quantitative assessment of the degeneration on the specific tracts in CSM is still rare. The aim of the present study was to use tractography-based quantification to investigate the column-specific degeneration in CSM. ⋯ Loss of microstructural integrity was detected in the lateral and posterior column in CSM. Tractography-based quantification was capable of evaluating the subtle pathological insult within white matter on a column-specific basis, which exhibited potential clinical value for in vivo evaluation of the severity of CSM.