Journal of Spinal Disorders & Techniques最新文献

{"title":"MRI Characterization of Vascular Spinal Tumors.","authors":"Kenneth S Bode,&nbsp;Kristen E Radcliff,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000051","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000051","url":null,"abstract":"<p><strong>Study design: </strong>Randomized trial.</p><p><strong>Objective: </strong>This study described practical magnetic resonance imaging (MRI) characteristics to assist in the identification of these tumors including the corresponding statistics.</p><p><strong>Summary of background data: </strong>Identification of vascular spinal tumors using MRI allows the opportunity for angiography and preoperative embolization (PE) to improve outcomes and decrease hemorrhage. The MRI characterization reliability of these tumors has not been described.</p><p><strong>Materials and methods: </strong>A retrospective comparison of 40 patients, at a single institution, with known spinal tumors was conducted with 20 vascular versus 20 nonvascular cases (based on postoperative pathology). Randomized MRI T1 precontrast/postcontrast and T2 images of these tumors were blinded and reviewed by 7 spine surgeons and 5 musculoskeletal radiologists. Four criteria were reviewed: T2 hyperintensity, contrast enhancement, flow voids, and feeding vessels. The clinical relevance was evaluated by asking if the reviewer recommended PE.</p><p><strong>Results: </strong>The specificity, sensitivity, and accuracy of each characteristic for surgeons were: T2 hyperintensity (65%, 85%, 75%), contrast enhancement (84%, 38%, 61%), flow voids (42%, 86%, 64%), and feeding vessels (35%, 90%, 63%). The results for the radiologists were: T2 hyperintensity (83%, 61%, 72%), contrast enhancement (87%, 32%, 60%), flow voids (44%, 93%, 69%), and feeding vessels (33%, 93%, 63%). Both the groups had low κ and intraclass correlation values. Review of angiography/PE recommendation showed that both surgeons and radiologists had a false-negative rate of 33%.</p><p><strong>Conclusions: </strong>Surgeons and radiologists have similar moderate accuracy of MRI vascularity identification. Radiologists have a higher sensitivity, but lower specificity. Even with simplified, straightforward criteria, the MRI characterization of vascular spinal tumors has low interobserver/intraobserver reliability with a false-negative rate for angiography/PE recommendation of 33%. Angiography may become more standard in the workup of spine tumors.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 10","pages":"E590-4"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31876019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Risk Factors for Recurrent Lumbar Disk Herniation in L5-S1.","authors":"Kyoung-Tae Kim,&nbsp;Dong-Hyun Lee,&nbsp;Dae-Chul Cho,&nbsp;Joo-Kyung Sung,&nbsp;Young-Baeg Kim","doi":"10.1097/BSD.0000000000000041","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000041","url":null,"abstract":"<p><strong>Background context: </strong>Although numerous studies have reported on recurrent lumbar disk herniation (rLDH), few have reported on recurrence of L5-S1 level.</p><p><strong>Purpose: </strong>We investigated whether the preoperative risk factors, such as disk degeneration, disk height, sagittal range of motion (sROM), width of L5 vertebral transverse process, and iliac crest height, have any effect on rLDH in L5-S1.</p><p><strong>Study design: </strong>A retrospective case control study.</p><p><strong>Patient sample: </strong>A total of 467 patients were enrolled in this study.</p><p><strong>Outcome measures: </strong>The disk degeneration, disk height, sROM, width of L5 vertebral transverse process, and iliac crest height were calculated using magnetic resonance imaging and simple radiography.</p><p><strong>Materials and methods: </strong>We compared the clinical parameters (age, sex, body mass index, symptom duration, diabetes, smoking, preoperative visual analogue scale, herniation type, annular defect size) and preoperative radiologic parameters [disk degeneration, disk height, sROM, relative width of L5 vertebral transverse process (RT), iliac crest height index (IHI)] of recurrent and nonrecurrent groups.</p><p><strong>Results: </strong>Patient with rLDH had its onset 39.4±17.9 months (7-90 mo) after primary surgery. Of the 39 rLDH cases, herniation was ipsilateral to previous LDH in 29 patients and contralateral in 10. Multiple logistic regression analysis showed that moderate disk degeneration with preserved height (group B), a large sROM, a small RT, a low IHI, and being male were significant risk factors for rLDH.</p><p><strong>Conclusions: </strong>Moderate disk degeneration, a large sROM, a small RT, and a low IHI are biomechanical risk factors of rLDH in L5-S1. The results also suggested being male and having a large annular defect increase recurrence after discectomy, especially in cases of ipsilateral rLDH.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 10","pages":"E571-7"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32558021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Upright Imaging for Evaluating Degenerative Lumbar Stenosis: Incidence of Degenerative Spondylolisthesis Missed on Supine MRI.","authors":"Brad Segebarth,&nbsp;Mark F Kurd,&nbsp;Priscilla H Haug,&nbsp;Rick Davis","doi":"10.1097/BSD.0000000000000205","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000205","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort.</p><p><strong>Background: </strong>Degenerative spondylolisthesis (DS) with lumbar stenosis is a well-studied pathology and diagnosis is most commonly determined by a combination of magnetic resonance imaging (MRI) and standing radiographs. However, routine upright imaging is not universally accepted as standard in all practices. To the best of our knowledge, there has been no study investigating the incidence of missed diagnosis of DS evident only on standing lateral or dynamic radiographs when compared with sagittal alignment on MRI.</p><p><strong>Objective: </strong>The authors hypothesize that supine MRI evaluation alone in lumbar degenerative disease will significantly underestimate the incidence of DS. Secondary hypothesis is that there will be no significant difference in detecting spondylolisthesis when comparing dynamic flexion-extension radiographs to standing lateral radiographs.</p><p><strong>Methods: </strong>We retrospectively evaluated all patients presenting to spine clinic for degenerative lumbar conditions from July 2004 to July 2006 who had an MRI, upright lateral, and flexion-extension radiographs at our institution. The incidence of DS found on dynamic flexion-extension radiographs but not on MRI was determined. We then reviewed each and compared flexion-extension versus standing lateral views to determine whether there was any significant difference in detecting anterolisthesis.</p><p><strong>Results: </strong>Of 416 patients with eligible studies, 109 were found to have DS at levels L4-L5, L5-S1, or L3-L4 based on flexion-extension radiographs. Of these, only 78 were found to have a corresponding spondylolisthesis on MRI, leaving 31/109 (28%) of DS levels undiagnosed on MRI. No additional anterolisthesis cases were detected on standing flexion-extension verses standing lateral radiographs.</p><p><strong>Conclusions: </strong>Routine standing lateral radiographs should be standard practice to identify DS, as nearly 1/3 of cases will be missed on supine MRI. This may have implications on whether or not an arthrodesis is performed on those patients requiring lumbar decompression. Flexion-extension radiographs demonstrated no added value compared with standing lateral x-rays for the purposes of diagnosing DS.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 10","pages":"394-7"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32778433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures: A 4-year Follow-up.","authors":"Dong Geun Lee,&nbsp;Choon Keun Park,&nbsp;Chan Jin Park,&nbsp;Dong Chan Lee,&nbsp;Jang Hoe Hwang","doi":"10.1097/BSD.0000000000000043","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000043","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Objective: </strong>New vertebral compression fracture (NVCF) is a highly potential risk after percutaneous vertebroplasty (PVP). The study aimed at analyzing the incidence and risk factors of NVCF and preventing its development.</p><p><strong>Summary of background data: </strong>PVP is widely used and highly effective technique for reducing pain caused by an osteoporotic vertebral compression fracture. However, there is a great deal of debate about whether PVP is associated with NVCF, and many risk factors of NVCF have been hypothesized.</p><p><strong>Methods: </strong>From January to December 2008, a total of 198 patients (176 women, 22 men; mean age, 76.6±0.5 y) who underwent PVP at 270 levels for painful osteoporotic VCF were retrospectively analyzed during a 4-year follow-up. The following parameters were evaluated: NVCF incidence and average time, body mass index (BMI), smoking history, the existence of trauma, and bone mineral density (BMD) before and after PVP. Cement location, intradiscal leakage, distribution pattern, kyphotic angle, sagittal index, compression ratio, injected cement volume, and numbers of fractures and thoracolumbar junction fractures were analyzed.</p><p><strong>Results: </strong>During follow-up, 34 patients (17.2%) sustained symptomatic NVCF for 4-year follow-up. All 34 patients with NVCF had lower BMD than that before initial PVP. For adjacent VCF, multivariable analysis showed that a higher risk of NVCF after vertebroplasty was associated with a larger number of VCF (P=0.025) and lower BMI (P=0.045), whereas for remote VCF, the risk of NVCF was higher in patients who had not experienced trauma and lower BMD (P=0.045). None of the radiographic evaluation values were related to the occurrence of NVCF.</p><p><strong>Conclusions: </strong>The most important elements related to reducing NVCF were treating osteoporosis and improving BMD and BMI. More aggressive BMD and BMI correction is more important than the vertebroplasty technique.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 10","pages":"E578-83"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31832037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microscopic Posterior Transdural Resection of Cervical Retro-Odontoid Pseudotumors","authors":"Yasushi Fujiwara, Hideki Manabe, T. Sumida, N. Tanaka, T. Hamasaki","doi":"10.1097/BSD.0000000000000335","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000335","url":null,"abstract":"Retro-odontoid pseudotumors are noninflammatory masses formed posterior to the odontoid process. Because of their anatomy, the optimal surgical approach for resecting pseudotumors is controversial. Conventionally, 3 approaches are used: the anterior transoral approach, the lateral approach, and the posterior extradural approach; however, each approach has its limitations. The posterior extradural approach is the most common; however, it remains challenging due to severe epidural veins. Although regression of pseudotumors after fusion surgery has been reported, direct decompression and a pathologic diagnosis are ideal when the pseudotumor is large. We therefore developed a new microscopic surgical technique; transdural resection. After C1 laminectomy, the dorsal and ventral dura was incised while preserving the arachnoid. Removal of the pseudotumor was performed and both of the dura were repaired. The patient’s clinical symptoms subsequently improved and the pathologic findings showed degenerative fibrocartilaginous tissue. In addition, no neurological deterioration, central spinal fluid leakage, or arachnoiditis was observed. Currently, the usefulness of the transdural approach has been reported for cervical and thoracic disk herniation. According to our results, the transdural approach is recommended for resection of retro-odontoid pseudotumors because it enables direct decompression of the spinal cord and a pathologic diagnosis.","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 1","pages":"363 - 369"},"PeriodicalIF":0.0,"publicationDate":"2015-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61620747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Clinical and Radiographic Results of Activ L Total Disk Replacement at 1- to 3-Year Follow-up.","authors":"Shibao Lu,&nbsp;Chao Kong,&nbsp;Yong Hai,&nbsp;Nan Kang,&nbsp;Lei Zang,&nbsp;Yu Wang,&nbsp;Yi Yuan","doi":"10.1097/BSD.0000000000000237","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000237","url":null,"abstract":"<p><strong>Study design: </strong>A prospective clinical study.</p><p><strong>Objective: </strong>To assess the clinical and radiographic results of activ L total disk replacement (TDR) on degenerative disk diseases.</p><p><strong>Summary of background data: </strong>There are few reports on Activ L TDR, and this is the first in China.</p><p><strong>Materials and methods: </strong>From March 2009 to March 2012, 32 patients with degenerative disk disease underwent either monosegmental or bisegmental lumbar TDR, which was documented in a prospective observational mode. Clinical success was defined as disability [Oswestry Disability Index (ODI)] improvement of at least 15 points versus baseline, no device failure, no major complications, no neurological deterioration. Additional clinical parameters as Visual Analogue Scale and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively (1, 2, and 3 y). Radiographic parameters as range of motion (ROM) and intervertebral disk height (IDH) of the index and adjacent segments were also carried out. Prosthesis subsidence and heterotopic ossification were observed during the follow-up period. Work status was tracked for all patients.</p><p><strong>Results: </strong>Overall, 30 patients (93.7%) were available for a mean follow-up of 28.8 months (12-46 mo) and had complete radiographic data. Their mean age was 45.1 years (32-58 y). At 3 years postoperatively, the success rate was 86.7% (26/30). After surgery, clinical parameters as Visual Analogue Scale score for back and leg pain, and ODI score showed statistically significant improvement (P<0.001), and the situation was well maintained during the follow-up time points. At 3 years postoperatively, the mean IDH at the index segment and upper and lower adjacent segments were 12.87, 12.61, and 11.62 mm, respectively, showing no significant difference compared with preoperative data (P1=0.0597, P2=0.6669, P3=0.9813). The ROM of the index and upper adjacent segment showed a slight but significant increase at the 3-year follow-up compared with baseline (P1=0.0128, P2=0.0007). The changes of ROM at the lower adjacent segment were not significant (P=0.6637). Tears of the iliac vein were observed in 2 patients. Prosthesis subsidence was observed in 3 patients (1 at 12 mo postoperatively, 1 at 24 mo postoperatively, and 1 at 32 mo postoperatively). Heterotopic ossification was observed in 1 patient at 36 mo postoperatively. At the 3-year follow-up, only 8 patients went back to their original work, and 15 patients changed jobs, whereas the last 7 patients stopped working.</p><p><strong>Conclusions: </strong>The 1- to 3-year follow-up of this cohort of patients showed satisfactory clinical outcomes. The IDHs at index and adjacent segments were well maintained after the surgery. The ROM at the lower adjacent segment remained unchanged, but the ROM at the index and upper adjacent segments showed a slight increase. The long-term results of activ L TD","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E544-50"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32926518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fusion Rates of Different Anterior Grafts in Thoracolumbar Fractures.","authors":"Maxime Antoni,&nbsp;Yann Philippe Charles,&nbsp;Axel Walter,&nbsp;Sébastien Schuller,&nbsp;Jean-Paul Steib","doi":"10.1097/BSD.0b013e3182aab2bf","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aab2bf","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective CT analysis of anterior fusion in thoracolumbar trauma.</p><p><strong>Objective: </strong>The aim of this study was to compare fusion rates of different bone grafts and to analyze risk factors for pseudarthrosis.</p><p><strong>Summary of background data: </strong>Interbody fusion is indicated in anterior column defects. Different grafts are used: autologous iliac crest, titanium mesh cages filled with cancellous bone, and autologous ribs. It is not clear which graft offers the most reliable fusion.</p><p><strong>Material and methods: </strong>Radiologic data of 116 patients (71 men, 45 women) operated for type A2, A3, B, or C fractures were analyzed. The average age was 44.6 years (range, 16-75 y) and follow-up was 2.7 years (range, 1-9 y). All patients were treated by posterior instrumentation followed by an anterior graft: 53 cases with iliac crest, 43 cases with mesh cages, and 20 with rib grafts. Fusion was evaluated on CT and classified into complete fusion, partial fusion, unipolar pseudarthrosis, and bipolar pseudarthrosis.</p><p><strong>Results: </strong>Iliac crest fused in 66%, cages in 98%, and rib grafts in 90%. The fusion rate of cages filled with bone was significantly higher as the iliac graft fusion rate (P=0.002). The same was applied to rib grafts compared with iliac crest (P=0.041). Additional bone formation around the main graft, bridging both vertebral bodies, was observed in 31 of the 53 iliac crests grafts. Pseudarthrosis occurred more often in smokers (P=0.042). A relationship between fracture or instrumentation types, sex, age, BMI, and fusion could not be determined.</p><p><strong>Conclusions: </strong>Tricortical iliac crest grafts showed an unexpected high pseudarthrosis rate in thoracolumbar injuries. Their cortical bone is dense and their fusion surface is small. Rib grafts led to a better fusion when used in combination with the cancellous bone from the fractured vertebral body. Titanium mesh cages filled with cancellous bone led to the highest fusion rate and built a complete bony bridge between vertebral bodies. Smoking seemed to influence fusion.</p><p><strong>Level of evidence: </strong>Case control study, Level III.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E528-33"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aab2bf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31768953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Level Circumferential Lumbar Fusion Comparing Midline and Paraspinal Posterior Approach: 5-Year Interim Outcomes of a Randomized, Blinded, Prospective Study.","authors":"Glenn R Buttermann,&nbsp;William J Mullin","doi":"10.1097/BSD.0000000000000029","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000029","url":null,"abstract":"<p><strong>Study design: </strong>A prospective randomized and blinded comparative study of 2 patient groups with >5-year follow-up.</p><p><strong>Objective: </strong>To compare the clinical outcomes and postoperative posterior muscle changes in patients with advanced degenerative disk disease undergoing 2-level circumferential spinal fusion using a posterior midline versus a paraspinal approach.</p><p><strong>Summary of background data: </strong>Lumbar spinal fusion is often performed using a circumferential (anterior and posterior) technique. Paraspinal muscle alterations occur during the retraction of the muscles required for posterior instrumentation and fusion bed preparation, which may adversely affect outcomes.</p><p><strong>Methods: </strong>Patients with advanced 2-level lumbar degenerative disk disease were randomized into 2 groups of 25 each for the approach to the posterior spine for their anterior-posterior fusion. A midline posterior skin incision was universal, but all patients were blinded to the fascial incision and exposure to the posterior spine. All had intertransverse and facet joint fusions with pedicle screw instrumentation. Outcomes (visual analog back and leg pain scale, pain drawing, Oswestry disability index, and self-assessment of procedure success) were assessed at various periods postoperatively. Preoperative and >1-year postoperative magnetic resonance images (MRI), including paraspinal muscles, were read by a radiologist who was blinded to the surgical approach and outcomes.</p><p><strong>Results: </strong>No difference in operative time, blood loss, implant costs, or any other intraoperative parameter existed between the 2 patient groups. Although clinical improvement for all outcome scales was significant for both groups postoperatively, there was no difference between groups. Postoperative MRI T2 relaxation values were significantly increased at the operative levels and distally, but the changes were similar for both groups.</p><p><strong>Conclusions: </strong>Midline and paraspinal approaches result in similar outcomes in 2-level spinal fusions. We were unable to demonstrate that a paraspinal muscle-splitting approach to 2-level fusion was superior to the muscle-stripping midline approach. However, the study has low statistical power.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"E534-43"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31816585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal Spinal Balance in Adult Spine Deformity Patients With Long Spinal Fusions: A Minimum 2- to 5-Year Follow-up Study.","authors":"Avraam Ploumis,&nbsp;Andrew K Simpson,&nbsp;Thomas D Cha,&nbsp;Joshua P Herzog,&nbsp;Kirkham B Wood","doi":"10.1097/BSD.0b013e3182aab2ff","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aab2ff","url":null,"abstract":"<p><strong>Study design: </strong>This study was a retrospective one.</p><p><strong>Objective: </strong>The objective of the study was to analyze the causes, prevalence of, and risk factors for coronal decompensation in long adult lumbar spinal instrumentation and fusion (from thoracic or upper lumbar spine) to L5 or S1.</p><p><strong>Summary of background data: </strong>Coronal and sagittal decompensation after long fusions for spinal deformities can affect outcomes negatively. There is no study reporting the natural history of coronal spinal balance after long spinal fusions.</p><p><strong>Methods: </strong>A single-center retrospective review of data from 54 patients with spinal deformity was performed. Inclusion criteria were patients over 18 years with long fusions (>4 segments) to L5 or the pelvis who had full spine standing radiographs before surgery and up to 2-5 years postoperatively. Radiographic data included C7PL, magnitude of scoliotic curve, shoulder or pelvic asymmetry in the coronal plane, thoracic kyphosis, lumbar lordosis, and pelvic parameters (pelvic incidence, pelvic tilt, sacral slope). Coronal imbalance (CI) was considered if the C7PL was >4 cm lateral to the central sacral line, and sagittal imbalance (SI) was considered when the C7 plumbline was >4 cm anterior to the middle of the upper sacral plate. Paired t test, χ test, and repeated measures regression analysis using demographic data (age, sex, body mass index), operative (previous fusion, posterior only or anteroposterior fusion, iliac fixation or not, decompression or not, osteotomy or not) and postoperative (complications, use of bracing) data, and radiographic parameters (including SI) were performed.</p><p><strong>Results: </strong>Patients showing CI equaled 11 (19.3%) preoperatively, remained 11 (19.3%) (4 of whom were new patients with CI) at 6 weeks postoperatively, and increased (P<0.001) to 18 (31.6%) (8 of them without initial CI) at 2-5 years follow-up. However, in terms of numeric distance of C7PL from the midsacrum, there was no statistically significant change (P>0.05) from preoperative to last follow-up. SI showed significant improvement (P<0.05) from preoperative to 6 weeks postoperative and no statistical significant change (P>0.05) from 6 weeks to 2-5 years postoperatively. Repeated measures regression analysis showed that the presence of osteoporosis and the combination of anterior approach surgery with a history of previous surgery were significant (P<0.05) factors predictive of changes in coronal balance.</p><p><strong>Conclusions: </strong>After surgical correction of spinal deformities, coronal spinal decompensation appears in an increased number of patients at last follow-up postoperatively but without significant differences in coronal plane C7PL during the postoperative period. Attention should be paid to patients with osteoporosis and those with a combination of previous same site posterior spine surgery and new anterior approach surgery fo","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"341-7"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aab2ff","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31768954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-Door or \"French-Door\" Cervical Laminoplasty.","authors":"Themistocles S Protopsaltis,&nbsp;Christine E Choi,&nbsp;Daniel J Kaplan","doi":"10.1097/BSD.0000000000000323","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000323","url":null,"abstract":"<p><strong>Purpose: </strong>Cervical spondylotic myelopathy (CSM) is a condition resulting from cervical stenosis. Manifestations of CSM include paresthesia in the extremities, loss of fine motor skills, balance problems, and bowel and bladder dysfunction in advanced disease. Laminoplasty is one surgical treatment option. The goal of laminoplasty is to reposition the laminae to expand the spinal canal, allowing the spinal cord to migrate posteriorly. There are various laminoplasty techniques; the main ones being open-door laminoplasty and double-door laminoplasty. This manuscript demonstrates a double-door laminoplasty otherwise known as a \"French-door\" laminoplasty discusses the indications and outcomes of this procedure.</p><p><strong>Methods: </strong>The double-door laminoplasty creates an opening in the midline of the spinous processes and a symmetrical expansion with hinges on both laminae. Bilateral troughs are drilled on each laminae using a bur, and opened liked a French-door, allowing the spinal cord to move posteriorly in the enlarged spinal canal. The space between the gapped laminae are then stabilized by allograft.</p><p><strong>Results: </strong>This manuscript presents the case of a 56-year-old man with CSM caused by multilevel cervical stenosis. The patient had classic signs and symptoms of CSM including problems with fine motor skills and walking difficulty. The video demonstrates the spinal cord decompression achieved with the French-door technique from C4 to C6 with a dome laminectomy at C3.</p><p><strong>Conclusions: </strong>There are many surgical treatments for cervical stenosis including anterior cervical discectomy and fusions and posterior procedures such as laminoplasty or laminectomy and fusion. The indications and technical pearls for French-door laminoplasty are presented as an effective option for the treatment of multilevel cervical stenosis.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 9","pages":"319-23"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34049585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}