The spine journal : official journal of the North American Spine Society
-
Comparative Study
All pedicle screw instrumentation for Scheuermann's kyphosis correction: is it worth it?
Scheuermann's kyphosis has long been treated by a two-staged fusion and instrumentation with a hybrid construct using hooks, pedicle screws, and sublaminar wires. Recent interest in all pedicle screw constructs led to its use in the treatment of Scheuermann's kyphosis. Evaluation of this newly described application is needed. ⋯ The use of multiple-level all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time, blood loss, and hospital stay without the need for anterior release. A better correction was achieved and preserved with the use of all pedicle screw constructs. This technique is a useful modality in the treatment of Scheuermann's kyphosis.
-
Somatosensory evoked potential (SSEP) is used to monitor integrity of the brain, spinal cord, and nerve roots during spinal surgery. It records the electrical potentials from the scalp after electrical stimulation of the peripheral nerves of the upper or lower limbs. The standard monitoring modality in lumbosacral spine surgery includes lower-limb SSEP and electromyography (EMG). Upper-limb SSEP monitoring has also been used to detect and prevent brachial plexopathy and peripheral nerve injury in thoracic and lumbosacral spine surgeries. We routinely monitor lower-limb SSEP and EMG in lumbosacral spine procedures at our institution. However, a few patients experienced postoperative numbness and/or pain in their ulnar distribution with uneventful lower-limb SSEP and EMG. ⋯ The present study demonstrates that upper-limb SSEP monitoring could detect position-related ulnar neuropathy in 5.2% of the patients undergoing lumbosacral spine surgery.
-
Case Reports
Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft.
A cerebrospinal fluid (CSF)-pleural fistula is a unique condition with which all spine surgeons need to be familiar, particularly those who use anterolateral approaches to the thoracic region. When direct suturing of the dural defect is not possible, techniques for indirect repair must be considered. ⋯ Anterolateral thoracic disc surgery poses a great challenge to the spine surgeon but can provide the most direct way of decompressing the spinal cord as a result of ventral pathology. Some of the most difficult aspects of dealing with a CSF leak in this area relates to 1) the relative complexity of suturing the dura directly as it is at a considerable distance from the operating surgeon; 2) the manner in which the contralateral dura slopes away and is hidden from view; and 3) the relatively negative intrathoracic pressure, which encourages the persistent flow of CSF from the intradural to the pleural cavity. We speculate that with open thoracic surgery and the creation of a large potential space with an open dural defect, this technique provided an additional barrier against the formation of a CSF-pleural fistula. Using this technique, we intentionally create a pseudomeningocele into the corpectomy defect that is contained within the confines of our dural-pleural graft.
-
It remains unknown whether aggressive disc removal with curettage versus conservative removal of a disc fragment with little disc invasion provides a better outcome for the treatment of lumbar disc herniation with radiculopathy. ⋯ There are no Level I studies to support conservative versus aggressive discectomy for the treatment of primary disc herniation. However, systematic review of the literature suggests that conservative discectomy may result in shorter operative time, quicker return to work, and a decreased incidence of long-term recurrent low back pain but with an increased incidence of recurrent disc herniation. Prospective randomized trails are needed to firmly assess this possible benefit.
-
Although previous studies have primarily focused on testing the effectiveness of cervical orthoses under properly fit conditions, this study focuses on analyzing the effects of an ill-fitted cervical orthosis (Miami J). This may have significance to health-care providers in understanding the effects of an improperly fitted neck brace. ⋯ To our knowledge, the effects of improperly fitted cervical orthoses on CRoM are still unknown. Using the NOB electromagnetic tracking system combined with VR feedback, we were able to consider the motion restriction of ill-fitting Miami J orthoses for both primary and combined motions. For both motion types, increased motion was possible when the subject was improperly fitted with the Miami J. If not considered, these excessive motions could potentially have detrimental effects on patient satisfaction, clinical outcomes, or even lead to increased secondary injury.