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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Comparative Study
Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study.
The operative results of 23 patients with a specific or unspecific spondylodiscitis were documented over 2 years after the focus of the inflammation had been eradicated, bone chip had been interposed and a CDH instrumentation had been performed by an anterior approach only. These outcomes were compared with the results of 32 patients in whom the focus had been removed and the defect had been filled with bone graft from an anterior approach, followed by stabilisation with CD instrumentation through an additional dorsal approach. In the cases where CDH instrumentation was applied, the range of fusion averaged 1.3 segments. ⋯ The mean loss of reposition was measured to be about 2.7 degrees in both groups. Average operation time and blood loss were about 50% higher in the patients treated dorsoventrally. We conclude that even in the case of florid spondylodiscitis, a short-range anterior fusion of the affected spinal segment may be performed by use of a stable-angle implant without an increased risk of infection-related loosening.
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Review Case Reports
Three-level thoracic disc herniation: case report and review of the literature.
A rare case of three-level thoracic disc herniation with associated neurological impairment, including motor, sensor and urinary disturbances, is reported. The diagnosis and localization of the level of cord compression were mainly based on the clinical examination supported by the findings of magnetic resonance imaging and somatosensory evoked potentials. ⋯ An improvement in the patient's subjective and neurological condition was already apparent a few months after the operation, and solid fusion was roentgenographically found at all operated levels. The use of a surgical microscope allows complete removal of the herniated disc while avoiding wide vertebrectomy and associated iatrogenic damage to the spinal cord.
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Review Case Reports
Symptomatic cystic dilatation of V ventricle: case report and review of the literature.
We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.
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Comparative Study
Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc?
Degeneration of the intervertebral disc, seen radiologically as loss of disc height, is often associated with apparent remodelling in the adjacent vertebral body. In contrast, maintenance or apparent increase in disc height is a common finding in osteoporosis, suggesting the properties of the intervertebral disc may be dependent on those of the vertebral body or vice versa. We have investigated this relationship by measuring the radiological thickness of the subchondral bone and comparing it to the chemical composition of the adjacent disc. ⋯ A weaker correlation was seen here between water content and thickness, whilst there was no significant correlation at the annulus or between the bone thickness and collagen content. The positive relationship between the radiographic thickness of vertebral subchondral bone and the proteoglycan content of the adjacent disc seen in human cadaveric material could be due to the bone responding to a greater hydrostatic pressure being exerted by discs with higher proteoglycan content than by those with less proteoglycan present. It is suggested that while this is true in "normal" specimens, the relationship becomes altered in disease states, possibly because of changes to the nutritional pathway of the disc, with resultant endplate-bone remodelling affecting the flow of solutes to and from the intervertebral disc.
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Multiple hereditary osteochondromatosis is a genetically transmitted disorder consisting of multiple projections of bone capped by cartilage, which are called exostoses. Spinal cord compression due to expansion of a laminar osteochondroma is rare but well recognized. Surgical decompression usually improves the patient's neurological status but, in cervical exostosis, post-laminectomy kyphosis and instability problems, especially in the high-risk adolescent group, form the most significant potential difficulties in the postoperative period. We report a case of cervical laminar exostosis that was treated by anterior stabilization and fusion and discuss the benefits of this technique.