The spine journal : official journal of the North American Spine Society
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Review Case Reports
Brown-Sèquard syndrome produced by cervical disc herniation: report of two cases and review of the literature.
Brown-Sèquard syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has rarely been considered to be a cause of Brown-Sèquard syndrome. ⋯ Characteristic finding in discogenic Brown-Sèquard syndrome are contralateral deficit in sensation of pain and temperature of more below than a few levels below the cord compression and paracentral protruded disc with cervical spinal stenosis. Outcomes are favorable in rapid diagnosis by magnetic resonance images and performance of anterior approach.
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Comparative Study
Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up.
Lateral mass plating has become the technique of choice for posterior cervical fixation. Although these systems are safe and reliable, they can be difficult to use in patients with abnormal cervical anatomy; screw placement can be compromised by the fixed hole spacing of the plate; screw back-out and other forms of implant failure can occur; and extension across the cervicothoracic junction can be problematic. ⋯ These data indicate that posterior cervical stabilization with polyaxial screw-rod fixation is a safe, straightforward technique that appears to offer some advantages over existing methods of fixation. Results appear to be durable at 1-year follow-up. Benefits are more significant with longer constructs, especially those extending to the occiput or crossing the cervicothoracic junction.
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Comparative Study
Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation.
A relatively high pseudarthrosis rate is associated with multilevel anterior cervical discectomy and fusion (ACDF). Anterior plate fixation increases fusion rate in multilevel ACDF. A debate still exists between the effectiveness of allograft versus autograft in plated multilevel ACDF. ⋯ A high fusion rate of 97.5% was obtained for multilevel ACDF with rigid plating with either autograft or allograft. In this study, nonunion occurred in patients with allograft but this difference was not statistically significant. Fusion was obtained in 97.8% of patients with segmental screw fixation and 97.1% with nonsegmental screw fixation. Nonsegmental screw fixation may contribute to less than adequate stability and contribute to a higher rate of nonunion, but such effects could not be discerned from this study. Excellent and good clinical outcome was noted in 88.8% of the patients. Proper patient selection and meticulous operative technique is essential to obtain high fusion rates and optimal clinical outcome, which is more important than graft type.
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Comparative Study
Correlation of clinical examination characteristics with three sources of chronic low back pain.
Research has demonstrated some progress in using a clinical examination to predict discogenic or sacroiliac (SI) joint sources of pain. No clear predictors of symptomatic lumbar zygapophysial joints have yet been demonstrated. ⋯ Significant correlations exist between clinical examination findings and symptomatic lumbar discs, zygapophysial and SI joints. The strongest relationships were seen between SI joint pain and three or more positive pain provocation tests, centralization of pain for symptomatic discs and absence of pain when rising from sitting for symptomatic lumbar zygapophysial joints.
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Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus.
Prior studies have documented an increased complication rate in diabetics treated by lumbar decompression. Despite the assumption that this risk would be exacerbated in larger fusion procedures, a recent study found no such increased risk. ⋯ Patients with both IDDM and NIDDM have a significantly increased risk of perioperative complications as compared with controls when treated by lumbar instrumentation and fusion.