Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series.

BACKGROUND: The long-term outcome of facet joint replacement (FJR) still is to be proven. METHODS: We present a prospective case series of 26 (male-to-female ratio of 1:1; mean age: 61 years) patients undergoing FJR with a follow-up of at least 1 year (range: 12-112; mean: 67 months). Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 12-Item Short Form Health Survey (SF-12) were applied pre- and postoperatively (after 3, 6, and 12 months) as well as at the last follow-up (N = 24). Using X-rays of the lumbar spine (N = 20), the range of motion (ROM) and disk height in the indicator and adjacent levels were assessed. RESULTS: FJR was performed at L3/L4 (N = 7), L4/L5 (N = 17), and L5/S1 (N = 2). Mean VAS (mm) for back pain decreased from 71 to 18, mean VAS for right leg pain from 61 to 7, and from 51 to 3 for the left leg. Mean ODI dropped from 51 to 22% (for all p < 0.01). Eighty seven percent of patients were satisfied and pretreatment activities were completely regained in 78.3% of patients. Disk height at the indicator and adjacent levels and ROM at the indicator segment and the entire lumbar spine were preserved. No loosening of implants was observed. Explantation of FJR and subsequent fusion had to be performed in four cases (15.4%). CONCLUSIONS: In selected cases, long-term results of FJR show good outcome concerning pain, quality of life, preservation of lumbar spine motion, and protection of adjacent level.

En bloc resection of non-small-cell lung cancer invading the spine.

OBJECTIVE: To describe our surgical en bloc approach and to assess the outcome and survival of non-small-cell lung cancer (NSCLC) invading the spine. METHODS: We retrospectively reviewed our prospective database of all patients, who underwent lung resection with en bloc hemivertebrectomy or total vertebrectomy for NSCLC between January 2003 and December 2008 in an individualized multimodality treatment concept. Survival was estimated by the Kaplan-Meier method. Log-rank analyses were used to compare groups. RESULTS: Twenty-eight patients (age 58.9 ± 12.9 years) were diagnosed with NSCLC invading the spine at a single center. Eight of those patients were inoperable. Twenty patients proceeded to surgery with en bloc hemivertebrectomy (n = 16) or total vertebrectomy (n = 4). Six patients had induction chemotherapy (30%). Complete resection could be achieved in 16 patients (80%). Morbidity was observed in eight patients (40%); no mortality occurred. Adjuvant radiation (n = 14) or chemoradiation (n = 6) was administered with 66 Gy. The mean survival and 5-year survival for patients, who underwent surgery (n=20), were 46.0 months and 47%, respectively. Inoperable patients had poorer survival (14.0 months; p = 0.004). Sublobar resections (p = 0.002) and incomplete resections (p = 0.02) were associated with inferior survival. Adjuvant chemoradiation (p = 0.088), hemivertebrectomy (p = 0.062), and age < 70 years (p = 0.076) trended toward prolonged survival. CONCLUSIONS: Multimodality treatment including en bloc lung resections with hemivertebrectomy or total vertebrectomy offer promising long-term survival in highly selected patients with NSCLC invading the spine. These extended resections can be performed with acceptable morbidity and mortality in specialized centers. Patients aged ≥ 70 years should be selected very carefully for radical resection. Sublobar resections should be avoided.

Radiological comparison of instrumented posterior lumbar interbody fusion with one or two closed-box plasmapore coated titanium cages: follow-up study over more than seven years.

STUDY DESIGN: A retrospective clinical study with a follow-up of more than 7 years was conducted. OBJECTIVE: To compare interbody fusion, segmental lordosis and changes in disc and foramen height in patients who had received instrumented posterior lumbar interbody fusion (PLIF) with 1 or 2 closed-box titanium cages. SUMMARY OF BACKGROUND DATA: PLIF using 2 cages is a popular surgical method for treating degenerative lumbar spinal diseases. Implantation of a single cage in instrumented PLIF is still controversial. METHODS: From 1994 to 1997, 46 patients with degenerative lumbar spinal disease underwent single-level instrumented PLIF surgery using 1 (n = 22) or 2 (n = 24) interbody rectangular-shaped titanium blocks coated with Plasmapore (Prospace, B. Braun Aesculap AG, Tuttlingen). Mean follow-up was 8 years, ranging from 7 to 10 years. Anteroposterior and lateral radiographs of the patients were taken immediately after surgery and at the last follow-up examination. Segmental stability, change in segmental height, foramen height, and segmental lordosis were evaluated in both groups. RESULTS: Eight years after surgery, segmental stability (1-cage: 95.5%; 2 cages: 95.8%; P > 0.05), change in segmental height (1-cage: -1.9% +/- 3.7%; 2-cage: -2.4% +/- 3.6%; P > 0.05), foramen height (1-cage: -3.7% +/- 9.9%; 2-cage: -6.6% +/- 6.5%; P > 0.05) and segmental lordosis (1-cage: -2.4 degrees +/- 4.8; 2-cage -1.0 degrees +/- 4.0; P > 0.05) did not differ significantly between the 2 groups. Due to adjacent segment syndrome, 3 patients with a previous 2-cage PLIF received additional fusion surgery. CONCLUSION: In the long-term, instrumented PLIF with a single closed-box titanium cage shows similar radiologic results compared to fusion with 2 titanium cages. Implantation of a single titanium closed-box cage in an instrumented PLIF seems to be adequate in case of degenerative lumbar spinal disease.

April 2004: woman in her early fifties with a cervical intraspinal and extraspinal mass lesion.

April 2004: A 53-year-old woman presented with a large club-shaped intra- and extraspinal tumor of the C6 nerve root which had intradurally grown through the enlarged C5-6 neural foramen and focally infiltrated the dura mater. Microscopy revealed a melanin-pigmented tumor with spindle-shaped and epithelioid cells and scattered psammoma bodies, a so-called psammomatous melanotic schwannoma (PMS). More than half of the patients with PMS have Carney complex, a genetically heterogeneous multiple neoplasia syndrome of autosomal-dominant inheritance, which in our patient, however, could not be detected unequivocally. Prognosis of all melanotic schwannomas (MSs) is not good with local recurrences or metastases in over 40% of cases. In our case, frequent versicular nuclei with distinct nucleoli, occasional mitoses and apoptoses and increased focal MIB-1 labeling indices prompted us to diagnose a malignant PMS. However, histologic criteria for malignancy in MSs are not clearly defined and there is no reliable histopathological indicator of malignant clinical behavior in MSs. Therefore, designation of "PMS with malignant histologic features" may be more appropriate. Since tumor recurrences and metastases im MSs may occur after more than 5 years, long-term follow-up of affected patients is required. One year after operation our patient showed no signs of tumor recurrence or metastases.