The spine journal : official journal of the North American Spine Society
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Successful placement of pedicle screws in the cervical spine requires a sufficient three-dimensional understanding of pedicle morphology to allow accurate identification of the screw axis. ⋯ The findings of our radiological anatomical study suggest that the preoperative CT scans of patients undergoing cervical transpedicular fixation should be thoroughly analyzed and close attention paid to the pedicle size and its angulation. The placement of cervical pedicle screws should be individualized for each patient and based on detailed preoperative planning.
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A spinal dural arteriovenous fistula (DAVF) is a known cause of venous congestive myelopathy. These lesions are thought to be acquired. There exist two prior reports that describe DAVF presenting with slowly progressive myelopathy years after lumbar disc surgery. ⋯ This represents the first case of an occult spinal DAVF becoming acutely symptomatic after lumbar disc surgery. Although the etiology of the lesion and its symptomatic progression remains unknown, an alteration of blood flow through the DAVF as a result of surgery may have resulted in progressive venous congestive myelopathy. The present case highlights the importance of considering a spinal DAVF in the differential diagnosis of any patient with signs of myelopathy or conus medullaris syndrome after lumbar discectomy. In addition, this case underscores the gravity of recognizing subtle features that suggest the presence of an occult vascular malformation on preoperative imaging, as symptomatic progression of these lesions carries significant potential morbidity.
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The utilization of motion-preserving implants versus conventional instrumentation systems, which stabilize the operative segments, necessitates improved understanding of their comparative biomechanical properties and optimal biomechanical method for surgical revision. ⋯ The findings highlight a variety of important trends at the operative and adjacent levels. In terms of revision strategies, posterior pedicle screw reconstruction combined with an existing Charité was not found acutely to be statistically different from pedicle screws combined with FRA.
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Anterior lumbar surgery is a common procedure for anterior lumbar interbody fusion and disc replacement but the impact of obesity on this procedure has not been determined. ⋯ Perioperative outcomes in obese and non-obese patients were comparable and obesity is not related to an increased risk of morbidity in anterior lumbar surgery.