The spine journal : official journal of the North American Spine Society
-
Randomized Controlled Trial
Disc height and motion patterns in the lumbar spine in patients operated with total disc replacement or fusion for discogenic back pain. Results from a randomized controlled trial.
Fusion is considered the "gold standard" in surgical treatment of degenerated disc disease; the intended postoperative goal is absence of mobility, but treatment may induce degeneration in adjacent segments. Total disc replacement (TDR) aims to restore and maintain mobility by replacing a painful disc. Little is known about the degree and quality of mobility in artificial discs in vivo and whether maintained mobility reduces the stress on adjacent segments that is believed to occur after fusion. ⋯ This very accurate X-ray method (DCRA) indicates that surgical goals were reached in most patients. This, however, was not correlated to clinical outcome. Differences between the groups in postoperative disc height at treated segments, respective ROM, and translation at adjacent segments did not affect the clinical outcome after 2 years.
-
Although the frequency of transpsoas lumbar interbody fusion procedures has increased in recent years, complication reports remain scarce in the literature. ⋯ Fracture can occur after transpsoas lumbar interbody fusion, even in nonosteoporotic patients. Factors, such as intraoperative end-plate breach, subsidence, compression by lateral screws, and cage rolling, could contribute to the development of fractures after transpsoas interbody fusion.
-
Spinal procedures have a potential of intraoperative contamination. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been used to diagnose postoperative infections after spinal surgery. However, it has not been demonstrated if there is an association between surgical site contamination and clinical manifestation of postoperative infection based on inflammatory markers and patients' clinical course. ⋯ The results of this study demonstrate that intraoperative contamination can occur during simple and complex spinal procedures. In the absence of postoperative signs of infection in patients with intraoperative contamination, there is no need of continuing antibiotic treatment. Postoperative kinetics of CRP and ESR showed to be the same in patients with and without intraoperative contamination. Higher levels of inflammatory markers were noted in complex spinal procedures where instrumentation was applied.
-
Detection of ossification of the posterior longitudinal ligament (OPLL) of lesions by lateral radiography is sometimes difficult because the lesions are small. Three-dimensional computed tomography (3D CT) imaging has made it possible to detect lesions not been seen by lateral radiography. ⋯ Three-dimensional computed tomography visualization of OPLL provided the basis of a classification system, superior to lateral radiography, and provided new information about OPLL. Combining 3D CT with MRI might be useful to provide details about spinal cord compression in OPLL.