The spine journal : official journal of the North American Spine Society
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There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. ⋯ The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
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Tuberculosis (TB) of the cervical spine occurs rarely in younger children whereas the presentation and outcome are different from those of adult cervical spine. Because cervical spinal TB in younger children is rarely reported, the clinical characteristics, the treatments, and the expected outcome of treatments in younger children are still unknown. ⋯ Based on our experiences in this case and a review of the literature, we propose that for patients of cervical spine TB in early childhood, anterior excision of diseased bone without grafting should be adequate as a surgical measure.
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Laminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis. ⋯ Despite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.
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Characteristic changes of the facet joints, including synovial cysts, facet joint hypertrophy, and facet joint effusions, on magnetic resonance imaging (MRI) and computed tomography have been associated with lumbar degenerative spondylolisthesis. The cervical facets have not been examined for associations with cervical degenerative spondylolisthesis similar to those seen in the lumbar spine. ⋯ Supine MRIs underestimate sagittal displacement compared with upright lateral radiographs. Asymmetric facet hypertrophy at C3-C4 and C4-C5 is associated with degenerative spondylolisthesis on upright lateral films even in the absence of anterolisthesis on supine MRIs.
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Although complete resection is the preferred surgical treatment for ossification of the ligamentum flavum (OLF), it sometimes results in the floating method because of adhesion to, or ossification of, the dura mater. It is difficult to anticipate the degree of floating, and if the floated ossification is large, decompression of the spinal cord may not be sufficient. ⋯ Our present study is the first report that showed OLF was reduced after the floating method. Reduction of the floated ossification was observed 5 weeks after the operation.