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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Surgical treatment of cervical spondylotic myelopathy (CSM) aims to prevent or delay the progression of the disease. Many patients are diagnosed in advanced stages of the disease, presenting severe functional disability and extensive radiologic changes, which suggests clinical irreversibility. There are doubts about the real benefit of surgery in patients who are seriously ill, bedridden or in a wheelchair. ⋯ In conclusion, two-thirds of patients with CSM Nurick scores of 5 who were either bedridden or in wheelchairs at the time of diagnosis improved at least one degree on the Nurick scale after surgical treatment, thus returning to walking. The JOAm scale was more sensitive to clinical changes than the Nurick scale. Patients with longer lengths of disease had worse outcomes.
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The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. ⋯ Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8 degrees ; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9-T10 and L1-L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy.
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The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients (>65 years old) who eventually had surgical treatment for CSM were evaluated. ⋯ However, there was no significant difference between the two groups. New postoperative DS appeared in four patients, of which two were from the DS group and two from the non-DS group. These data suggest that degenerative spondylolisthesis does not influence surgical results in elderly cervical spondylotic myelopathy patients.
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Motor evoked potentials (MEPs) study using transcranial magnetic stimulation (TMS) may give a functional assessment of corticospinal conduction. But there are no large studies on MEPs using TMS in myelopathy patients. The purpose of this study is to confirm the usefulness of MEPs for the assessment of the myelopathy and to investigate the use of MEPs using TMS as a screening tool for myelopathy. ⋯ All patients in the operative group showed prolongation of MEPs or CMCTs or multiphase of the MEP wave. MEP abnormalities are useful for an electrophysiological evaluation of myelopathy patients. Moreover, MEPs may be effective parameters in spinal pathology for deciding the operative treatment.
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Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. ⋯ There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.