The spine journal : official journal of the North American Spine Society
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Among the various forms of laminoplasty fixation, plate augmentation provides a semirigid arch reconstruction and is gaining popularity as the result of its safety and effectiveness. However, the effects of this procedure on hinge status and subsequent bony healing remain unclear. ⋯ Although plate-only, open-door laminoplasty is a safe and reliable surgery for decompression of multilevel cervical disease, the fixation that it provides on the open side may not be sufficiently stable to allow successful primary healing. Additional attention should be paid to the hinged side to prevent delayed fracture in the early postoperative period and to reduce postoperative axial pain.
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Vocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied. ⋯ Vocal cord palsy is a significant morbidity after anterior cervical surgery with incidence up to 24.2% in the immediate postoperative period, with a higher risk in reoperation of the anterior cervical spine. Moderate evidence exists for ETT cuff pressure adjustment in preventing this complication.
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Although giant cell tumors (GCTs) are histologically benign, they may become locally aggressive bone tumors. As these lesions tend to respond poorly to radio- and chemotherapy, currently the standard surgical paradigm for the treatment of spinal GCTs involves en bloc surgical resection. Denosumab is a newly developed monoclonal antibody designed to inhibit the receptor activator of nuclear factor kappa-B ligand (RANKL) which has already been demonstrated to induce marked radiographic responses on GCTs of the appendicular skeleton. Nevertheless, the role of denosumab in the treatment algorithm of GCTs of the spine has not yet been defined. ⋯ This is the first report of sustained long-term complete clinical and radiographic regression of a GCT of the spine after treatment with the new RANKL antibody denosumab. Although future long-term follow-up studies are still necessary to establish important key points regarding the best therapeutic protocol with such a new drug (such as the optimal time frame to keep the patient under treatment), denosumab promises to bring major changes to the current therapeutic paradigm for GCTs of the spine, which, up to now, has strongly relied on en bloc surgical resection.