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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Cervical laminectomy is a reliable tool for posterior decompression in various cervical spine pathologies. Although there is increasing evidence of superior clinical, neurological and radiological outcomes when using anterior cervical decompression, laminectomy can be a valuable tool when combined with instrumented lateral mass fusion for carefully selected indications. ⋯ This review article will provide decision-making guidance, technical advice and pitfalls. The technical advice for laminectomy and instrumented lateral mass fusion is illustrated. The authors review the literature on outcomes and complications and suggest indications for the safe and successful application of cervical laminectomy and lateral mass fusion.
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To conduct a systematic review of the literature to determine important clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). ⋯ The most important predictors of outcome were preoperative severity and duration of symptoms. This review also identified many other valuable predictors including signs, symptoms, comorbidities and smoking status.
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Multicenter Study
Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis.
Anterior column reconstruction (ACR) is a minimally invasive technique for the treatment of sagittal plane deformity. ACR uses a lateral transpsoas approach with ALL release and the application of an interbody device to achieve correction. Here, we present 1-year radiographic results from a multicenter study of adult spinal deformity (ASD) patients. ⋯ ACR successfully restores lumbar lordosis in ASD patients with sagittal imbalance. ACR results in greater segmental correction than is achieved with LLIF alone. Supplementing with posterior osteotomies allows for even greater correction. The ability to achieve the desired radiographic goals is expected to improve as technical nuances are refined and patient selection is optimized.
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Clinical Trial
Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation.
The purpose of this study was to assess the mid-term clinical and radiological results as well as patient safety in terms of complication and reoperation rates in patients treated with a novel anterior stand-alone fusion (ASAF) device (Synfix-LR, DePuy Synthes, West Chester, PA, USA) in a cohort of patients with predominant and intractable low back pain originating from monosegmental degenerative disc disease at the lumbosacral junction. ⋯ The current study delineates satisfactory clinical results following ASAF at the lumbosacral junction. Patient safety was demonstrated with acceptable complication and low reoperation rates. Radiological data demonstrated a significant reconstruction of lordosis at the lumbosacral junction. Solid interbody fusion was achieved in 97.3 % of all cases in a highly selected cohort with optimal predisposition for fusion. ASAF may serve to avoid a variety of negative side effects for a considerable number of patients which, otherwise, would have been candidates for posterior instrumented fusion techniques.
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To investigate the relationship between sagittal spinal alignment and the incidence of vertebral fracture in patients with osteoporosis. ⋯ Osteoporosis patients with low LL, LLI, and PI could be at high risk of lumbar vertebral fracture. In addition to BMD, the abnormal sagittal spinal profile should also be taken into consideration when predicting the incidence of vertebral fracture in such patients.