The spine journal : official journal of the North American Spine Society
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Neuroforaminal stenosis is one of the key factors causing clinical symptoms in patients with cervical radiculopathy. Previous quantitative studies on the neuroforaminal dimensions have focused on measurements in a static position. Little is known about dimensional changes of the neuroforamina in the cervical spine during functional dynamic neck motion under physiological loading conditions. ⋯ The dimensional changes of the cervical neuroforamina showed segment-dependent characteristics during the dynamic flexion-extension. These data may have implications for diagnosis and treatment of patients with cervical radiculopathy.
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A common complication of cervical laminectomy and fusion with instrumentation (CLFI) is development of postoperative C5 nerve palsy. A proposed etiology is excess nerve tension from posterior drift of the spinal cord after decompression. We hypothesize that laminectomy width will be significantly increased in patients with C5 palsy and will correlate with palsy severity. ⋯ This is the largest series of C5 palsies after laminectomy documented with CT imaging. Laminectomy width was not associated with an increased risk of postoperative C5 palsy at any level. Reduction in laminectomy width may not reduce rate of postoperative nerve palsy.
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Multicenter Study
The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis.
Various factors are reported to affect the spinal alignment in degenerative lumbar scoliosis (DLS). Although trunk muscles also appear to affect spinal alignment, the role of the trunk muscles is not yet clear. ⋯ The CSAs of the MF and PS were significantly smaller in the DLS group. Whole-body DXA showed no significant difference in the lean composition between the groups. There were significant correlations in the DLS patients between the MF CSA and sagittal spinal alignment. These findings suggest the causal relationship between muscles and global spine alignment.
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Magnetically controlled growing rods (MCGRs) are used in the management of early-onset scoliosis (EOS). Each MCGR contains a telescopic actuator that serves as the distraction element when stimulated by an external remote controller (ERC), permitting non-invasive lengthening in the outpatient clinic. ⋯ Clinicians should have a high index of suspicion of structural implant failure when presented with histories similar to those reported in our first case, or following unsuccessful distraction of MCGRs. In such cases new radiographs should be taken, and all previous images should be reviewed for evidence of this phenomenon. Centers that document MCGR lengthening with ultrasound should obtain plain radiographs every 6 months to evaluate the structural integrity of the implant.
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The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures. ⋯ Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk.