Journal of Spinal Disorders & Techniques最新文献

{"title":"Reduction of Leg Pain by Oxiplex Gel After Lumbar Discectomy in Patients With Predominant Leg Pain and Elevated Levels of Lower Back Pain: A Prospective, Randomized, Blinded, Multicenter Clinical Study.","authors":"Wei Lei,&nbsp;Ronald J Ehmsen,&nbsp;Richard P Chiacchierini,&nbsp;John L Krelle,&nbsp;Gere S diZerega","doi":"10.1097/BSD.0b013e3182a35590","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a35590","url":null,"abstract":"<p><strong>Study design: </strong>A prospective, randomized, blinded, multicenter clinical study.</p><p><strong>Objective: </strong>To evaluate carboxymethylcellulose/polyethylene oxide gel (Oxiplex) in improving clinical outcomes in subjects having predominant leg pain and elevated low back pain undergoing first-time lumbar discectomy for disk herniation.</p><p><strong>Summary of background data: </strong>Clinical studies in the United States and Italy found that Oxiplex reduced leg pain after decompression surgery.</p><p><strong>Methods: </strong>A total of 68 subjects with herniated lumbar disk were enrolled and randomized into treatment (surgery plus gel) or surgery-only control groups. A prospective statistical analysis assessed the effect of gel in the severe back pain subgroup (prespecified as greater than or equal to median baseline back pain of the population studied). All subjects except 2 controls lost to follow-up completed the study. Preoperative and postoperative visual analogue scale leg pain scores were analyzed and compared between groups at 60 days after surgery.</p><p><strong>Results: </strong>There were no serious adverse events or neurological safety concerns reported in any patients. Gel-treated patients had statistically significantly lower visual analogue scale leg pain scores at study end compared with controls (P=0.0240), representing a 21% additional reduction in leg pain compared with surgery alone in the severe baseline back pain subgroup (P=0.0240). The proportion of subgroup patients experiencing zero leg pain at study end was significantly higher in the gel treatment group (60%) than in the control group (23%) (P=0.0411).</p><p><strong>Conclusions: </strong>The data from this study confirm and extend results of 2 previous studies in Italy and the United States that reported statistically significantly greater reductions in leg pain in gel-treated patients with severe preoperative low back pain compared with patients who only underwent decompression surgery.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"301-7"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a35590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31616522","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 Study of Posterior Lumbar Interbody Fusion With Either Interbody Graft or Interbody Cage in the Treatment of Degenerative Spondylolisthesis.","authors":"A Sivaraman,&nbsp;Farhaan Altaf,&nbsp;Azal Jalgaonkar,&nbsp;Rahul Kakkar,&nbsp;P B R Sirigiri,&nbsp;A Howieson,&nbsp;Robert J Crawford","doi":"10.1097/BSD.0b013e31829baac1","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829baac1","url":null,"abstract":"<p><strong>Study design: </strong>A prospective study of 2 different fusion techniques for the treatment of single-level degenerative spondylolisthesis.</p><p><strong>Objective: </strong>To determine whether the addition of an intervertebral cage improves the clinical outcome and fusion rate of patients undergoing posterior lumbar interbody fusion (PLIF) after decompression for degenerative spondylolisthesis.</p><p><strong>Summary of background data: </strong>The surgical approach that should be used for degenerative spondylolisthesis is a controversial issue. Decompression and PLIF with an interbody cage is widely used. Theoretical advantages in favor of PLIF include anterior column support, indirect foraminal decompression, restoration of lordosis, and reduction of the slip via ligamentotaxis. Despite numerous publications, the scientific support for the PLIF method is, however, weak.</p><p><strong>Materials and methods: </strong>A prospective study was carried out including 59 patients with degenerative spondylolisthesis. Average age of patients was 66 years: 34 males and 25 females. Patients were divided into 2 treatment groups: group 1-32 patients with PLIF with interbody graft and group 2-27 patients with PLIF with cage. Minimum 2-year follow-up. Outcomes were assessed by measuring preoperative and postoperative lordotic angles. SF-12 physical and mental health scores were recorded along with visual analogue scores for pain. Complications were also recorded.</p><p><strong>Results: </strong>No significant difference in the postoperative lordotic angles was achieved between the 2 techniques. Nonsignificant difference in the clinical outcomes between both the techniques.</p><p><strong>Conclusions: </strong>We have found the use of a cage to achieve lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis does not confer any significant advantages in terms of restoration of lumbar lordosis, improvement in clinical symptoms, or relief of pain postoperatively.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E467-71"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829baac1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31209112","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":"Antifibrinolytic Use and Blood Transfusions in Pediatric Scoliosis Surgeries Performed at US Children's Hospitals.","authors":"Lisa M McLeod,&nbsp;Benjamin French,&nbsp;John M Flynn,&nbsp;John P Dormans,&nbsp;Ron Keren","doi":"10.1097/BSD.0b013e3182a22a54","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a22a54","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study using the Pediatric Health Information Systems database.</p><p><strong>Objective: </strong>To determine the association between antifibrinolytic use and red cell transfusions in spinal fusion operations performed at 37 US Children's Hospitals.</p><p><strong>Summary of background data: </strong>Evidence from randomized clinical trials and systematic reviews suggests that antifibrinolytic therapy can significantly reduce blood loss in children undergoing scoliosis surgery; however, the effectiveness of these agents as used in surgeries performed at US children's has not been studied.</p><p><strong>Materials and methods: </strong>We included children aged 0-18 years with diagnoses indicating adolescent idiopathic scoliosis (AIS) or neuromuscular scoliosis (NMS) for whom a spinal fusion procedure was performed between January 1, 2006 and September 30, 2009. Patients with malignancy, trauma, coagulation disorders, or for whom a cell salvage device was employed were excluded. Multilevel logistic regression was used to determine associations between ε-aminocaproic acid (EACA), tranexamic acid (TXA), and aprotinin (APR) use and blood transfusions, controlling for patient and surgery characteristics.</p><p><strong>Results: </strong>Cohorts consisted of 2722 AIS and 1547 NMS procedures. Antifibrinolytic use varied across hospitals (AIS 3.3%, interquartile range, 0%-42%; NMS 12 interquartile range, 0%-46%), and was significantly associated with NMS, posterior fusion, number of vertebrae fused. Overall, 15% of children received EACA, 7% TXA, and 2% APR. The median hospital-specific rate of red cell transfusions was 24% for AIS and 43% for NMS. In AIS operations, EACA use, but not TXA use, was associated with significantly lower odds of transfusion (odds ratio, 0.42; P<0.001 vs. odds ratio, 1.0; P=0.8). In NMS operations, neither EACA nor TXA use was associated with a decrease in odds of red cell transfusions.</p><p><strong>Conclusions: </strong>The effectiveness of antifibrinolytics as used outside of clinical trials is unclear and should continue to be explored. Future prospective research is needed to evaluate which administration protocols will most benefit patients, as well as to determine the comparative effectiveness of these drugs in the context of other blood conservation strategies.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E460-6"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a22a54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31780809","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":"Does the Outcome of Adult Deformity Surgery Justify the Complications in Elderly (Above 70 y of Age) Patients?","authors":"Sigurd H Berven,&nbsp;Nicole A Hohenstein,&nbsp;Jason W Savage,&nbsp;Clifford B Tribus","doi":"10.1097/BSD.0000000000000322","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000322","url":null,"abstract":"Deformity of the spine is an important disorder affecting the aging spine, and management of spinal deformity with operative care accounts for a significant and increasing portion of our health care economy. In the United States, the “Baby Boomers” born between 1946 and 1964 are a large and significant population of older Americans who are more racially diverse, better educated, and have higher expectations for activity than previous generations.2 Spinal deformity is among the most prevalent spinal disorders in the aging population, and has a significant impact on health-related quality of life (HRQOL).3 Population-based studies demonstrate increasing prevalence of degenerative spinal disorders with age. Schwab et al demonstrated spinal deformity in over 60% of adult volunteers over the age of 60. The role of surgery in the management of symptomatic spinal deformity in the elderly patient is variable, and requires careful consideration of risks of surgery and expected outcomes. Minimizing the risk of surgery while optimizing outcome and durability of surgery remains the goal of a value-based approach to care. An informed and shared decision between the patient and physician is important in pursuing an evidence-based approach to care. Many surgical interventions in our elderly population are cost-effective and return patients to an age-appropriate health status. Appropriate surgical interventions are those in which the expected health benefits of surgery (eg, increased life expectancy, relief of pain, reduction in anxiety, improved functional capacity) exceed the expected negative consequences (eg, mortality, morbidity, anxiety, pain, time lost from work) by a sufficiently wide margin.5 Smith et al6 demonstrated that there are significantly higher complications in elderly patients with spinal deformity compared with a younger population. However, the improvement of HRQOL was also significantly greater in older patients, yielding a similar ratio of risk and benefit. In a comparison with younger patients (45 y of age and below), Scheer et al7 found that elderly patients (65 y of age and above) who underwent pedicle subtraction osteotomy had more preoperative deformity, and were more likely to reach a minimum clinically important difference after surgery than younger patients. These results demonstrate that the risk to benefit ratio may be similar between older and younger patients, and that surgical care may be as appropriate in older patients. Surgical treatment of patients with symptomatic spinal deformity leads to a greater increase in HRQOL scores compared with nonoperative techniques. Sciubba et al8 demonstrated that patients over 75 years of age who underwent Z4-level spinal fusion had significant improvement in pain and disability, and reported a significant increase in HRQOL 2 years after surgery compared with patients treated nonoperatively. There is a clear relationship between surgical realignment including improvement of C7 SVA and match","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"271-4"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34020873","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":"Comparison of Thoracoscopic Anterior Release Combined With Posterior Spinal Fusion Versus Posterior-only Approach With an All-pedicle Screw Construct in the Treatment of Rigid Thoracic Adolescent Idiopathic Scoliosis.","authors":"Zhicai Shi,&nbsp;Jiayu Chen,&nbsp;Chao Wang,&nbsp;Ming Li,&nbsp;Quan Li,&nbsp;Ye Zhang,&nbsp;Cheng Li,&nbsp;Yuehua Qiao,&nbsp;Guo Kaijin,&nbsp;Chen Xiangyang,&nbsp;Bo Ran","doi":"10.1097/BSD.0b013e3182a2658a","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a2658a","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effect of thoracoscopic anterior release combined with posterior spinal fusion and posterior-only approach with an all-pedicle screw construct in the treatment of rigid thoracic adolescent idiopathic scoliosis.</p><p><strong>Methods: </strong>From June 2001 to June 2010, 63 patients who were admitted to our hospital with thoracic Cobb angle ≥80 degrees and the flexibility ≤40% were enrolled in our study. They were treated with either a combined anterior/posterior spinal fusion with hooks and screws (group A, n=25) or a posterior spinal fusion alone with an all-pedicle screw construct (group B, n=38). The thoracic Cobb angle in the standing whole-spine anteroposterior x-ray, thoracic kyphosis (T5-T12) Cobb angle, imaging examination parameters, fixation segments, implant density, and complications between the 2 groups were compared.</p><p><strong>Results: </strong>There were no significant differences in operation time, bleeding volume, length of hospital stay, preoperative coronal, sagittal Cobb, coronal curve flexibility, or postoperative coronal Cobb correction ratio between the 2 groups. Moreover, no significant difference in the Scoliosis Research Society-22 score at the last follow-up was present in the 2 groups, although it had been improved compared with that presented during the preoperative period. The implant density of group A (44±4%) was significantly lower than that of group B (55±5%) (P<0.001). In group A, the main complication was chylothorax (n=2) and hemopneumothorax (n=2). In group B, acute intestinal obstruction was observed in 2 patients and pleural effusion was observed in 1 patient. In addition, 12 screws were misplaced (12/403, 3.0%) in group B.</p><p><strong>Conclusions: </strong>In patients with rigid thoracic adolescent idiopathic scoliosis, posterior-only approach with an all-pedicle screw construct could achieve the same curve correction as a combined anterior/posterior spinal fusion by increasing the implant density. However, for scoliosis patients with a high risk of implant complications, anterior release combined with posterior spinal fusion is still recommended.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E454-9"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a2658a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32470891","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":"Complications and Outcomes for Surgical Approaches to Cervical Kyphosis.","authors":"Matthew J Grosso,&nbsp;Roy Hwang,&nbsp;Ajit A Krishnaney,&nbsp;Thomas E Mroz,&nbsp;Edward C Benzel,&nbsp;Michael P Steinmetz","doi":"10.1097/BSD.0b013e318299953f","DOIUrl":"https://doi.org/10.1097/BSD.0b013e318299953f","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The primary objective of this study is to report the safety and efficacy of the different surgical approaches to cervical deformity correction surgery.</p><p><strong>Summary of background data: </strong>Cervical subaxial deformity surgery has been shown to be an effective means to alleviate pain and improve neurological function in symptomatic patients. The reported outcomes and complications for the different surgical approaches (ventral, dorsal, and combined) are limited to small retrospective studies. The appropriate surgical approach is at times unclear, which is likely attributed to the overlap in indications for the ventral and combined approach.</p><p><strong>Materials and methods: </strong>A retrospective review of 76 patients who underwent cervical deformity surgery for cervical kyphosis at 1 institution was performed. The authors reviewed the complications, radiographic outcomes, and long-term functional outcomes for all patients.</p><p><strong>Results: </strong>The majority of patients in all groups reported excellent (15%) or good (50%) outcomes, with a mean improvement in modified Japanese orthopedic association score of 1.3. There were 26 perioperative complications (34%) for 19 patients (25%). We found the ventral-alone and combined approaches to achieve similar degrees of correction (23.1 and 23.2 degrees, respectively). The combined approach had the highest complication rate of the 3 approaches (combined: 40%, ventral: 30%, dorsal: 27%). The dorsal, ventral, and combined approaches had a mean neurological improvement in modified Japanese orthopedic association scores of 1.95, 3.00, and 1.26, respectively, and mean pain improvement of 0.8, 2.0, and 1.4.</p><p><strong>Conclusions: </strong>Given the moderate improvements in long-term outcomes, and the risks for perioperative complications, we recommend a careful selection process for patients eligible for cervical deformity surgery. We found that the ventral approach has reduced complications, similar degree of correction capability, and potentially higher improved neurological outcomes compared to the combined approach.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E385-93"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e318299953f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31478983","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":"Does Pathogen Identification Influence the Clinical Outcomes in Patients With Pyogenic Spinal Infections?","authors":"Julio Urrutia,&nbsp;Mauricio Campos,&nbsp;Tomas Zamora,&nbsp;Valentina Canessa,&nbsp;Patricia Garcia,&nbsp;Jorge Briceno","doi":"10.1097/BSD.0b013e3182a1476a","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a1476a","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To study the clinical outcomes of patients suffering from pyogenic spinal infections (PSI), by comparing the outcomes of patients with an identified microbiological agent with those of patients without an identified pathogen.</p><p><strong>Summary of background data: </strong>PSI is associated with significant risks for morbidity and mortality. Specific antibiotic treatment has been considered a key to successful medical treatment; however, clinicians frequently treat patients with PSI without an identified agent. A paucity of data is available comparing the clinical outcomes of patients with or without an identified pathogen.</p><p><strong>Materials and methods: </strong>The records of 97 consecutive patients discharged from a University Hospital with the diagnosis of PSI during a 14-year period were retrospectively reviewed. Patients' demographics, etiological agent, comorbidities, site of infection, white blood cell count, erythrocyte sedimentation rate, C-reactive protein at the time of presentation, neurological impairment, length of hospital stay, and mortality were registered to compare the clinical outcomes of patients with an identified pathogen with those of patients without an identified agent.</p><p><strong>Results: </strong>The causative organism was identified in 74 patients (76.3%). Patients with microbiological diagnosis were younger, and a larger percentage of them exhibited elevated C-reactive protein value; however, they were not different from those without an identified agent in terms of sex, site of infection, comorbidities, and the presence of a concomitant infection. Our study could not demonstrate different neurological outcomes, length of stay, or mortality rates among the 2 groups.</p><p><strong>Conclusions: </strong>In a large series of patients with PSI, we did not demonstrate differences in clinical outcomes using empirical antibiotics in patients without an identified pathogen compared with patients with an identified microbiological agent receiving specific antibiotics. Future prospective multicenter studies should be conducted to obtain an answer to this important clinical question.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E417-21"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a1476a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32169873","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":"Core Needle Percutaneous Transpedicular Vertebral Body Biopsy: A Study of 128 Cases.","authors":"Yoichi Kamei,&nbsp;Jun Nishida,&nbsp;Yoshikuni Mimata,&nbsp;Hideo Shiraishi,&nbsp;Shigeru Ehara,&nbsp;Takashi Satoh,&nbsp;Tadashi Shimamura","doi":"10.1097/BSD.0b013e31829c077a","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829c077a","url":null,"abstract":"<p><strong>Study design: </strong>We report an accurate technique for percutaneous transpedicular core needle biopsy of vertebral body lesions, and evaluate its effectiveness for histologic diagnosis retrospectively.</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the effectiveness and accuracy of this method retrospectively.</p><p><strong>Summary of background data: </strong>Better knowledge of vertebral pedicle morphometry has led to the development of transpedicular fixation techniques in spinal surgery. After experience with these techniques, we have been performing percutaneous transpedicular vertebral body core needle biopsies (transpedicular biopsy) for histologic diagnosis since 1993.</p><p><strong>Methods: </strong>A total of 128 patients who had undergone transpedicular biopsy for T1-L5 vertebral body lesions were evaluated. The biopsies were carried out under local anesthesia, except in children, for whom general anesthesia was used. Biopsy specimens were obtained by passing 8 or 11 G needle biopsy instruments percutaneously through the pedicle into the site of the lesion under C-arm fluoroscopy guidance. Histologic analyses were performed, and the accuracy and effectiveness of this technique were evaluated.</p><p><strong>Results: </strong>The pathologic evaluations were definitive in 120 patients (93.8%) and not diagnostic in 8. The accuracy of the results differed among the diagnostic categories. Diagnostic accuracy was 78.6% for primary neoplasms and 97.0% for metastatic neoplasms. There was a significant difference in the diagnostic criteria and spinal segment. True positive rate was higher in the thoracic spine (92.2%) than that of lumbar spine (76.6%).</p><p><strong>Conclusions: </strong>Transpedicular biopsy is a useful procedure for evaluation of thoracic and lumbar vertebral body lesions.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E394-9"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829c077a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31209113","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":"Femoral Neurogram Before Transpsoas Spinal Access at L4-5 Intervertebral Disk Space: A Proposed Screening Tool.","authors":"Timothy T Davis,&nbsp;Thomas F Day,&nbsp;Hyun W Bae,&nbsp;Alexandre Rasouli","doi":"10.1097/BSD.0b013e31829cc16c","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829cc16c","url":null,"abstract":"<p><strong>Study design: </strong>Observational study.</p><p><strong>Objective: </strong>To illustrate the variability of the course of the femoral nerve across the L4-5 disk space, and to present a novel application of transforaminal epidural steroid injections (TFESI) in the visualization of femoral nerve roots.</p><p><strong>Summary of background data: </strong>A concern regarding the lateral retroperitoneal transpsoas approach is the proximity of the lumbar plexus. Current techniques of assessing the proximity of neural tissue to the L4-5 disk space have limited capabilities.</p><p><strong>Methods: </strong>A total of 100 patients were selected for L4-5 TFESI (L4 selective nerve root blocks) because of lumbar radiculopathy. L4 neurograms were obtained while performing L4-5 TFESI under flouroscopic guidance, using a retroneural technique. The course of the L4 root/femoral nerve was then evaluated under fluoroscopy in the anteroposterior and lateral planes. Images were then reviewed by a radiologist, physiatrist, and 2 orthopedic spine surgeons.</p><p><strong>Results: </strong>Fluoroscopic evaluation revealed that the pattern of location of the femoral nerve was highly variable. In males, it was located 4.7% in zone 2, 32.5% in zone 3, 53.5% in zone 4, and 9.3% in zone P. In female patients, it was located 7.0% in zone 2, 14% in zone 3, 54.4% in zone 4, and 24.6% in zone P.</p><p><strong>Conclusions: </strong>An L4 neurogram will provide an accurate trajectory of L4 root/femoral nerve as it crosses the L4-5 intervertebral disk space. An accurate assessment is essential to help minimize the increasing frequency of thigh pain, paresthesias, and weakness associated with the lateral access to the L4-5 intervertebral disk space. Femoral nerves that fall within zones 2 and 3 will require more manipulation during retraction and may be better suited with a different surgical approach.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E400-4"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829cc16c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31209114","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":"Pediatric Cervical Spine Injuries: A Rare But Challenging Entity.","authors":"Florian Baumann,&nbsp;Toni Ernstberger,&nbsp;Carsten Neumann,&nbsp;Michael Nerlich,&nbsp;Gregory D Schroeder,&nbsp;Alexander R Vaccaro,&nbsp;Markus Loibl","doi":"10.1097/BSD.0000000000000307","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000307","url":null,"abstract":"<p><strong>Background: </strong>Injuries to the cervical spine in pediatric patients are uncommon. A missed injury can have devastating consequences in this age group. Because of the lack of routine in diagnosis and management of pediatric cervical spine injuries (PCSI), each of these cases represents a logistic and personal challenge.</p><p><strong>Methods: </strong>By means of clinical cases, we demonstrate key points in diagnostics and treatment of pediatric spine injuries. We highlight typical pediatric injury patterns and more adult-like injuries.</p><p><strong>Results: </strong>The most common cause of injury is blunt trauma. There is an age-related pattern of injuries in pediatric patients. Children under the age of 8 frequently sustain ligamentous injuries in the upper cervical spine. After the age of 8, the biomechanics of the cervical spine are similar to adults, and therefore, bony injuries of the subaxial cervical spine are most likely to occur. Clinical presentation of PCSI is heterogeneous. Younger children can neither interpret nor communicate neurological abnormalities, which make timely and accurate diagnosis difficult. Plain radiographs are often misinterpreted. We find different types of injuries at different locations, because of different biomechanical properties of the immature spine. We outline that initial management is crucial for long-term outcome.</p><p><strong>Conclusions: </strong>Knowledge of biomechanical properties and radiographic presentation of the immature spine can improve the awareness for PCSI. Diagnosis and management of pediatric patients after neck trauma can be demanding.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E377-84"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34001009","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}