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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Great care should be taken to minimise damage to the pharynx and upper oesophagus during an anterior approach to the cervical spine. If noticed at the time of surgery primary repair should be carried out; if noticed in the postoperative period, thorough cleaning and placement of a pharyngocutaneous drain will result in spontaneous healing of the majority of fistula. For persistent fistula secondary repair is required using well-vascularised tissue.
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We describe cases presenting with progressive thoracic myelopathy after lumbopelvic fusion attributed to proximal junctional vertebral compression fracture (PJF) followed by spinal calcium pyrophosphate dehydrate (CPPD) crystal deposition. ⋯ The combination of mechanical stress plus PJF and CPPD crystal deposition followed by a foreign body reaction to the deposited crystals caused myelopathy. Patients with radiographic evidence of PJF, especially UIV collapse, after lumbopelvic fusion should be followed carefully for the emergence of myelopathy.
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Symptomatic thoracic disc herniations (TDHs) are uncommon and can be surgically treated. Although transthoracic decompression is considered the gold standard, it is associated with significant comorbidities. In particular, approach via a posterior laminectomy has been associated with poor results. Several strategies have been developed for the resection of TDHs without manipulating the spinal cord. We describe a minimally invasive technique by using 3-D navigation and tubular retractors with the aid of a robotic holder via an oblique paraspinal approach. ⋯ The oblique paraspinal approach may offer an alternative surgical option for treating TDHs.