The spine journal : official journal of the North American Spine Society
-
There have been many follow-up studies on anterior interbody fusion for cervical nerve root and spinal cord compression, and excellent neurological outcomes have been reported. However, postoperative degenerative changes at adjacent discs may lead to the development of new radiculopathy or myelopathy. In the previous reports, the incidence of symptomatic adjacent segment disease has ranged from 7% to 15%. ⋯ The incidence of symptomatic adjacent segment disease after ACIF was higher when preoperative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the levels fused, preoperative alignment, spinal canal diameter or fusion alignment.
-
It is known that postoperative motor palsy at the C5 level occurs with anterior decompression or posterior decompression and has a relatively good prognosis, but the pathogenesis and possible prophylactic measures of the palsy remain unknown. ⋯ There were no specific risk factors among the preoperative clinical findings related to C5 palsy. Bilateral partial foraminotomy was effective for preventing C5 palsy.
-
There are both absolute and relative indications for the removal of pedicle screw fixation in the lumbar spine. Whatever the reasons are, removal of this hardware has required a surgical dissection that has been generally as extensive as the one used for their initial placement. These dissections are always disabling in the short term. In fact, the magnitude of this disabling pain can be significant enough so as to effectively eliminate screw removal as a logical treatment option for many conditions where indications for removal are only relative. Percutaneous pedicle screw fixation has served to amplify the stakes associated with this dilemma. In fact, this new technique makes the need for a less invasive method of pedicle screw removal greater now than ever. ⋯ Unlike most other minimal access surgical procedures, the learning curve for this procedure appears to be relatively flat. Removal of pedicle screw fixation in the manner described proved to be simple and straightforward. The benefits are dramatic and immediate. It is possible to complete the procedure within minutes, and the pain produced is best described as inconsequential. This minimally invasive technique radically alters both the intraoperative and postoperative courses for those who face pedicle screw removal. The disadvantages associated with the standard open approach are reduced to the production of mild short-term discomfort and an exposure to the potential risks of brief anesthesia and the possibility of a surgical infection. Considering that hospital stay should be limited to I day or less and that surgical times are less than I hour, minimally invasive removal or revision of hardware should reduce overall costs significantly.