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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Transarticular C1/2 screws are widely used in posterior cervical spine instrumentation. The use of pedicle screws in the cervical spine remains uncommon. Due to superior biomechanical stability compared to lateral mass screws, pedicle screws can be used, especially for patients with poor bone quality or defects in the anterior column. ⋯ Therefore, this technique may be used in a clinical setting, as it offers improved accuracy and reduced radiation dose for the patient and the medical staff. Nevertheless, users should take note of known sources of possible faults causing inaccuracies in order to prevent iatrogenic damage. Small pedicles, with a diameter of less than 4.0 mm, may not be suitable for pedicle screws.
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The Modular Type SB Charite disc prosthesis has been developed as a device for artificial disc replacement (ADR) in patients with symptomatic discopathies. Here, we report on our first series of 50 (out of 350) patients, who had a satisfactory clinical result in 70% of cases (2 years' follow-up). Subgroup analysis revealed that patients with an isolated discopathy without previous spinal operations or other pathology at the same or other spinal level benefitted more from the surgery. ⋯ We conclude that in patients with severe isolated symptomatic discopathies that are resistant to conservative treatment, a mobile disc prosthesis is worth considering as a real alternative to a spondylodesis. However, accurate patient selection is imperative. With these criteria we were encouraged by our results to continue the implantation of this artificial disc.
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It has been found that the pain patterns in pain drawings are related to the presence of herniated disc identified by myelography. The purpose of this study was to determine whether the pattern of pain in the drawings or the type of pain indicated (aching, burning, numbness, pins and needles, stabbing) was related to the presence of symptomatic disc pathology identified by CT/discography. In a subgroup of patients who underwent myelography, the relationship of the drawings to myelographic findings was also investigated. ⋯ Patients with discogenic pain used more symbols indicating burning pain and aching pain than did non-discogenic pain patients. Our results confirmed those reported earlier by Uden, who found a relationship between the pattern of pain in the drawings and myelographic findings. Pain drawings may be helpful in the diagnosis of symptomatic disc pathology.
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The association between peridural scarring and recurrent pain after lumbar discectomy is much debated. A recently published study found that patients with extensive peridural fibrosis were 3.2 times more likely to experience recurrent radicular pain than those with less extensive scarring. This finding may lead to an overestimation of peridural fibrosis in clinical practice. ⋯ The amount of fibrosis was divided into four stages in each affected quadrant. We found no differences regarding the amount of peridural fibrosis between patients with radicular pain and patients with non-radicular pain. We conclude that the extent of peridural scarring as defined by MRI is of minor value in the differential diagnosis of recurrent back and leg pain after lumbar microdiscectomy.