ABSTRACT
BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.
Subject(s)
Low Back Pain , Spinal Stenosis , Wound Infection , Humans , Laminectomy/methods , Retrospective Studies , Decompression, Surgical/methods , Spinal Stenosis/surgery , Treatment Outcome , Lumbar Vertebrae/surgery , Low Back Pain/surgery , Wound Infection/surgeryABSTRACT
BACKGROUND This single-center study included 80 patients with multilevel cervical ossification of the posterior longitudinal ligament (OPLL) and aimed to compare postoperative sagittal balance following treatment with expansive open-door laminoplasty (LP) vs total laminectomy with fusion (LF). MATERIAL AND METHODS Data of 80 patients with multilevel OPLL treated with LP vs LF between January 2017 and January 2022 were retrospectively analyzed. The basic data, cervical sagittal parameters, and clinical outcomes of the patients were counted in the preoperative and postoperative periods, and complications were recorded. Forty patients underwent LP and 40 underwent LF. Cervical sagittal parameters were compared between and within the 2 groups. Clinical outcomes and complications were compared between the 2 groups. RESULTS At last follow-up, the postoperative C2-C7 Cobb angel, T1 slope (T1S), and C7 slope (C7S) were significantly higher in the LF group than in the LP group (P<0.001). C2-C7 SVA (cSVA) was slightly higher in the LF group (P>0.05) and significantly higher in the LP group (P<0.05). The incidence of postoperative complications in the LP group was significantly lower than in the LF group (P=0.02). The postoperative scores on the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopedic Association (JOA) were significantly improved in both groups (P<0.001). CONCLUSIONS Both procedures had good outcomes in neurological improvement. After posterior surgery, the cervical vertebrae all showed a tilting forward. Compared to LP, LF may change cervical balance in Cobb angel, T1S. LF has better efficacy in improving cervical lordosis compared with LP. Patients with high T1 slope after surgery may has more axial pain.
Subject(s)
Cervical Vertebrae , Laminectomy , Laminoplasty , Ossification of Posterior Longitudinal Ligament , Spinal Fusion , Humans , Ossification of Posterior Longitudinal Ligament/surgery , Laminoplasty/methods , Laminoplasty/adverse effects , Male , Female , Retrospective Studies , Laminectomy/methods , Laminectomy/adverse effects , Middle Aged , Spinal Fusion/methods , Spinal Fusion/adverse effects , Cervical Vertebrae/surgery , Aged , Treatment Outcome , Postoperative Complications/etiology , Postoperative Period , Postural Balance/physiology , AdultABSTRACT
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.
Subject(s)
Decompression, Surgical , Laminectomy , Ligamentum Flavum , Thoracic Vertebrae , Humans , Decompression, Surgical/methods , Endoscopy/methods , Laminectomy/methods , Ligamentum Flavum/surgery , Neuroendoscopy/methods , Ossification, Heterotopic/surgery , Postoperative Complications/epidemiology , Thoracic Vertebrae/surgery , Treatment OutcomeABSTRACT
The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39 years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47 months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.
Subject(s)
Intervertebral Disc Displacement , Lumbar Vertebrae , Humans , Intervertebral Disc Displacement/surgery , Intervertebral Disc Displacement/diagnosis , Male , Adult , Female , Lumbar Vertebrae/surgery , Middle Aged , Radiculopathy/surgery , Radiculopathy/diagnosis , Magnetic Resonance Imaging , Diagnosis, Differential , Laminectomy/methods , Young Adult , Arteriovenous Fistula/surgery , Arteriovenous Fistula/diagnosisABSTRACT
PURPOSE: Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia. PATIENTS AND METHODS: A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared. RESULTS: Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach. CONCLUSION: Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences. LEVEL OF EVIDENCE: 3 (Retrospective case-control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.
Subject(s)
Arnold-Chiari Malformation , Decompression, Surgical , Foramen Magnum , Neuroendoscopy , Humans , Arnold-Chiari Malformation/surgery , Arnold-Chiari Malformation/diagnostic imaging , Female , Male , Foramen Magnum/surgery , Adult , Decompression, Surgical/methods , Retrospective Studies , Middle Aged , Neuroendoscopy/methods , Treatment Outcome , Young Adult , Laminectomy/methodsABSTRACT
PURPOSE: To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. METHODS: A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints. RESULTS: After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2 years postoperatively. CONCLUSIONS: Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.
Subject(s)
Cervical Vertebrae , Chondromatosis, Synovial , Laminectomy , Humans , Male , Child , Cervical Vertebrae/surgery , Cervical Vertebrae/diagnostic imaging , Laminectomy/methods , Chondromatosis, Synovial/surgery , Chondromatosis, Synovial/diagnostic imaging , Paralysis/etiology , Paralysis/surgery , Treatment Outcome , Recovery of Function , Spinal Cord Compression/surgery , Spinal Cord Compression/etiology , Spinal Cord Compression/diagnostic imaging , Magnetic Resonance ImagingABSTRACT
PURPOSE: Preoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty. METHODS: Three elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters. RESULTS: With its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH's epidural components thanks to XperCT-guidance. CONCLUSION: When facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH's angioarchitecture, significantly reducing tumor.
Subject(s)
Hemangioma , Spinal Neoplasms , Vertebroplasty , Humans , Hemangioma/surgery , Hemangioma/diagnostic imaging , Spinal Neoplasms/surgery , Spinal Neoplasms/complications , Spinal Neoplasms/diagnostic imaging , Aged , Female , Vertebroplasty/methods , Male , Spinal Cord Compression/surgery , Spinal Cord Compression/etiology , Thoracic Vertebrae/surgery , Thoracic Vertebrae/diagnostic imaging , Blood Loss, Surgical/prevention & control , Embolization, Therapeutic/methods , Aged, 80 and over , Treatment Outcome , Laminectomy/methods , Silicones , Decompression, Surgical/methodsABSTRACT
BACKGROUND: Cervical posterior instrumentation and fusion is often performed to avoid post-laminectomy kyphosis. However, larger comparative analyses of cervical laminectomy with or without fusion are sparse. METHODS: A retrospective, two-center, comparative cohort study included patients after stand-alone dorsal laminectomy with (n = 91) or without (n = 46) additional fusion for degenerative cervical myelopathy with a median follow-up of 59 (interquartile range (IQR) 52) months. The primary outcome was the C2-7 Cobb angle and secondary outcomes were Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, revision rates, T1 slope and C2-7 sagittal vertical axis (C2-7 SVA) at final follow-up. Logistic regression analysis adjusted for potential confounders (i.e. age, operated levels, and follow-up). RESULTS: Preoperative C2-7 Cobb angle and T1 slope were higher in the laminectomy group, while the C2-7 SVA was similar. The decrease in C2-7 Cobb angle from pre- to postoperatively was more pronounced in the laminectomy group (- 6° (IQR 20) versus -1° (IQR 7), p = 0.002). When adjusting for confounders, the decrease in C2-7 Cobb angle remained higher in the laminectomy group (coefficient - 12 (95% confidence interval (CI) -18 to -5), p = 0.001). However, there were no adjusted differences for postoperative NDI (- 11 (- 23 to 2), p = 0.10), mJOA, revision rates, T1 slope and C2-7 SVA. CONCLUSION: Posterior cervical laminectomy without fusion is associated with mild loss of cervical lordosis of around 6° in the mid-term after approximately five years, however without any clinical relevance regarding NDI or mJOA in well-selected patients (particularly in shorter segment laminectomies of < 3 levels).
Subject(s)
Cervical Vertebrae , Kyphosis , Laminectomy , Spinal Fusion , Humans , Laminectomy/adverse effects , Laminectomy/methods , Male , Cervical Vertebrae/surgery , Cervical Vertebrae/diagnostic imaging , Female , Spinal Fusion/adverse effects , Spinal Fusion/methods , Middle Aged , Kyphosis/surgery , Kyphosis/diagnostic imaging , Kyphosis/etiology , Retrospective Studies , Aged , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Spinal Cord Diseases/surgery , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/etiology , Treatment OutcomeABSTRACT
BACKGROUND: For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. METHODS: The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. RESULTS: We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12-30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). CONCLUSIONS: Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.
Subject(s)
Lordosis , Osteoporosis , Pedicle Screws , Spinal Fusion , Humans , Laminectomy/adverse effects , Laminectomy/methods , Lordosis/diagnostic imaging , Lordosis/etiology , Lordosis/surgery , Retrospective Studies , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Cervical Vertebrae/pathology , Spinal Fusion/adverse effects , Spinal Fusion/methods , Pedicle Screws/adverse effects , Osteoporosis/complicationsABSTRACT
PURPOSE: We aimed to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by an ultrasonic bone curette (UBC) for treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MIS-TLIF for treating severe DLSS. METHODS: The clinical data of 128 patients with single-segment severe DLSS who were admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using an ultrasonic bone curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate back and lower limb pain before the operation,immediate postoperative, and one week, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were employed to evaluate the improvement in low back and lower limb function. At the last follow-up, the Bridwell bone graft fusion standard was utilized to evaluate bone graft fusion. RESULTS: The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less in those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS back scores than the control group immediate postoperative and one week after the operation(P < 0.05). The UBC group had better VAS lower limb scores than the control group immediate postoperative (P < 0.05).The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before,three, six months, one year, and two years after surgery (P > 0.05). The ZCQ scores did not differ significantly between the two groups before the operation at one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up. CONCLUSIONS: UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can achieve clinical efficacy as traditional tool unilateral fenestration bilateral decompression MIS-TLIF and reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-ups. Therefore, this is a safe and effective surgical method.
Subject(s)
Decompression, Surgical , Lumbar Vertebrae , Spinal Fusion , Spinal Stenosis , Humans , Spinal Stenosis/surgery , Spinal Stenosis/diagnostic imaging , Female , Male , Decompression, Surgical/methods , Lumbar Vertebrae/surgery , Lumbar Vertebrae/diagnostic imaging , Retrospective Studies , Middle Aged , Aged , Spinal Fusion/methods , Spinal Fusion/instrumentation , Treatment Outcome , Laminectomy/methods , Bone Transplantation/methods , Severity of Illness Index , Minimally Invasive Surgical Procedures/methods , Pain Measurement , Ultrasonic Surgical Procedures/methods , Ultrasonic Surgical Procedures/instrumentationABSTRACT
BACKGROUND: Although cervical laminoplasty is a frequently utilized surgical intervention for cervical spondylotic myelopathy, it is primarily performed using conventional open surgical techniques. We attempted the minimally invasive cervical laminoplasty using biportal endoscopic approach. METHODS: Contralateral lamina access is facilitated by creating space through spinous process drilling, followed by lamina hinge formation. Subsequently, the incised lamina is elevated from ipsilateral aspect, and secure metal plate fixation is performed. CONCLUSION: We successfully performed the cervical open door laminoplasty using biportal endoscopic approach. Biportal endoscopic cervical open-door laminoplasty may be a minimally invasive technique that can prevent complications related with open surgery.
Subject(s)
Laminoplasty , Spinal Cord Diseases , Spinal Osteophytosis , Humans , Laminoplasty/adverse effects , Treatment Outcome , Spinal Cord Diseases/surgery , Cervical Vertebrae/surgery , Laminectomy/methods , Spinal Osteophytosis/surgery , Retrospective StudiesABSTRACT
BACKGROUND: The technique of spinal decompression under endoscopy has been widely applied, but reports on endoscopic cervical fixation are rare. The unilateral biportal endoscopic (UBE) technique stands out for its lesser muscle intrusion and more flexible surgical approach. METHOD: We applied the UBE approach for cervical fixation and laminectomy. We achieved bilateral lateral mass screw fixation by making an auxiliary UBE portal combined with the Roy-Camille and Magerl techniques. CONCLUSIONS: Our successful implementation of cervical fixation using the UBE technique at the C3/4 level suggests its efficacy. This approach is a valuable and minimally invasive option for cervical fixation.
Subject(s)
Cervical Vertebrae , Endoscopy , Humans , Cervical Vertebrae/surgery , Cervical Vertebrae/diagnostic imaging , Endoscopy/methods , Endoscopy/instrumentation , Bone Screws , Decompression, Surgical/methods , Decompression, Surgical/instrumentation , Laminectomy/methods , Laminectomy/instrumentation , Male , Middle Aged , FemaleABSTRACT
Intraosseous occurrence of a spinal AVM is anecdotal, with only four such cases reported previously. This is the first report of a spinal intraosseous AVM in the cervical vertebrae. A 44-year-old male patient presented with a 2-month history of progressive quadriparesis and bladder dysfunction. Magnetic resonance imaging showed multiple flow voids within the C4 and C5 vertebral bodies, and an extradural component causing cord compression. CT showed extensive bony destruction at both levels. The diagnosis of an intraosseous AVM was confirmed with spinal angiography. The AVM was noted to be fed by branches from the ascending cervical arteries and the vertebral artery. The nidus was draining into the vertebral venous plexus and thence into the jugular vein through the marginal sinus. The patient underwent partial embolization of the AVM. Surgical resection was attempted but found to be unfeasible due to torrential bleeding. A 360-degree stabilization along with decompressive laminectomies was performed, resulting in clinical improvement and disease stabilization at one year follow-up. The case and its management dilemmas are discussed in light of a brief literature review.
Subject(s)
Arteriovenous Malformations , Cervical Vertebrae , Embolization, Therapeutic , Humans , Male , Adult , Cervical Vertebrae/surgery , Cervical Vertebrae/diagnostic imaging , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/surgery , Arteriovenous Malformations/therapy , Embolization, Therapeutic/methods , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgery , Vertebral Artery/abnormalities , Spinal Cord Compression/surgery , Spinal Cord Compression/etiology , Spinal Cord Compression/diagnostic imaging , Treatment Outcome , Magnetic Resonance Imaging , Laminectomy/methods , Decompression, Surgical/methodsABSTRACT
OBJECTIVES: After a successful percutaneous cylindrical electrode five-to-seven-day trial of spinal cord stimulation, subsequent permanent surgical paddle lead (SPL) placement can be impeded by epidural scar induced by the trial leads (TLs). Our goal was to determine whether a delay between TL and subsequent SPL placement provokes enhanced epidural scarring with an increased need for laminotomy extension required for scar removal for optimal SPL placement. MATERIALS AND METHODS: Using a prospectively maintained data base, a single-facility/surgeon retrospective study identified 261 patients with newly placed thoracolumbar SPLs from June 2013 to November 2023. Data were obtained from the patients' charts, including, but not limited to, timing between TL and SPL, operative time, and need for extension of laminotomy. RESULTS: We found that the need for laminotomy extension due to TL epidural scarring and longer operative times was not required in our patients if the SPL was placed within ten days of placement of the TL (0/26), leading to shorter operative times in those with SPL placed after ten days (122.42 ± 10.72 minutes vs 140.75 ± 4.72 minutes; p = 0.005). We found no association with other medical comorbidities that may be confounding factors leading to epidural scarring/extension of laminotomy or association with level of SPL placement, size of the spinal canal, or indication for SPL placement. CONCLUSIONS: TL placement leads to scarring in the epidural space that appears to mature after ten days of its placement. In approximately 34% of patients, this leads to prolonged operative time owing to the need for extension of laminotomy and subsequent clearing of epidural scar for optimal SPL placement.
Subject(s)
Cicatrix , Electrodes, Implanted , Epidural Space , Spinal Cord Stimulation , Humans , Spinal Cord Stimulation/methods , Spinal Cord Stimulation/instrumentation , Cicatrix/etiology , Female , Male , Middle Aged , Electrodes, Implanted/adverse effects , Retrospective Studies , Aged , Adult , Laminectomy/methods , Laminectomy/adverse effects , Prospective StudiesABSTRACT
This report describes a unique case of thoracic vertebral canal stenosis and vertebral instability in a 1 yr old Minuet cat. The cat presented with a history of chronic progressive nonambulatory paraparesis. Myelography with neutral and stress positions revealed dynamic compression at T1-4. Computed tomography and MRI revealed multiple sites of vertebral endplate osteolysis, adjacent bone sclerosis, intervertebral disk space narrowing, and spondylotic bridging within the cervical and cranial thoracic vertebral bodies and pedicles, particularly at C6-T4. The cat underwent a right-sided T1-4 hemilaminectomy and C7-T4 vertebral stabilization using positively threaded profile pins and polymethylmethacrylate. The cat fully recovered without any complication. The case highlights the potential for young cats, especially those with a chondrodysplastic condition, to develop vertebral canal stenosis and vertebral instability. The surgical treatment described herein resulted in an excellent outcome.
Subject(s)
Spinal Cord Compression , Animals , Constriction, Pathologic/surgery , Constriction, Pathologic/veterinary , Spinal Cord Compression/surgery , Spinal Cord Compression/veterinary , Laminectomy/veterinary , Laminectomy/methods , Spinal Canal/surgery , Thoracic Vertebrae/surgeryABSTRACT
To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis (CS). The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People's Hospital were retrospectively analyzed. Of the patients, 16 were male and 12 were female, the mean age was (55.6±9.6) years. The CS occurred at C3-4 level in 1 cases, at C4-5 level in 3 cases, at C5-6 level in 16 cases and at C6-7 level in 8 cases. Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association (JOA) score. The postoperative complications were recorded. The JOA improvement rate was computed at the final follow-up. As a result, all patients underwent successful surgery and were followed up for (11.6±4.7) months. The operation time was (43.0±5.3) min. Intraoperative blood loss (7.9±2.8) ml; Postoperative drainage volume (8.1±2.3) ml. The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery, and it was 13.7±1.2 at the last follow-up, the differences between postoperative and preoperative were both statistically significant (both P<0.001). No complications occurred, such as cerebrospinal fluid leakage, nerve injury and intraspinal hematoma. At the last follow-up, cervical spine X-ray or CT evaluation showed no instability in the operative segment. The overall curative effect was evaluated according to JOA score at the last follow-up: 16 cases got excellent outcome, 7 cases got good and 2 cases got medium outcome, with an excellent and good rate of 89.3% (25/28). This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy, has no impact on spinal stability, and has a high safety.
Subject(s)
Cervical Vertebrae , Decompression, Surgical , Endoscopy , Laminectomy , Spinal Stenosis , Humans , Female , Male , Middle Aged , Decompression, Surgical/methods , Laminectomy/methods , Retrospective Studies , Spinal Stenosis/surgery , Cervical Vertebrae/surgery , Endoscopy/methods , Treatment Outcome , Postoperative ComplicationsABSTRACT
PURPOSE OF THE STUDY: Laminectomy with fusion (LF) is commonly performed with laminoplasty (LP) for cervical myelopathy. Foraminal stenosis is important in the surgical treatment of cervical myelopathy. LF and LP can affect foraminal size in different ways. This study aimed to compare foraminal dimensions after LF and LP using a medical computer-assisted design (CAD) program. MATERIAL AND METHODS: Computed tomography (CT) scans of the cervical vertebrae of 16 patients with cervical myelopathy were retrospectively viewed in the Digital Imaging and Communications in Medicine format on a CAD program. CT images were reformatted in an oblique plane perpendicular to the long axis of each foramen from C2-C3 to C6-C7. The narrowest foraminal crosssectional dimension (FCD) was measured and compared between the LF and LP groups at the operated, non-operated, and C4-C5 levels. The difference between the preoperative and postoperative FCDs was also calculated and compared between the operated and C4-C5 levels. Intra- and interobserver reliabilities for FCD measurements were evaluated using intraclass correlation coefficients. RESULTS AND DISCUSSION: At the operated spinal levels, the LF and LP groups showed decreased and increased mean FCDs, respectively. At the adjacent non-operated levels, the mean FCD slightly increased in both the groups. In the LF group, the difference between the preoperative and postoperative FCDs in the C4-C5 levels was larger than that in the other operated levels, but this difference was insignificant. CONCLUSIONS: LF and LP showed contrary results for FCD. Therefore, FCD and kyphosis should be considered for LF and LP. KEY WORDS: three-dimensional, foraminal cross-sectional dimension, laminoplasty, laminectomy fusion, computer-aided design, drafting system, preoperative-postoperative comparison.
Subject(s)
Cervical Vertebrae , Imaging, Three-Dimensional , Laminectomy , Laminoplasty , Spinal Fusion , Tomography, X-Ray Computed , Humans , Laminectomy/methods , Cervical Vertebrae/surgery , Cervical Vertebrae/diagnostic imaging , Laminoplasty/methods , Spinal Fusion/methods , Female , Male , Tomography, X-Ray Computed/methods , Retrospective Studies , Imaging, Three-Dimensional/methods , Middle Aged , Spinal Cord Diseases/surgery , Spinal Cord Diseases/diagnostic imaging , AgedABSTRACT
PURPOSE: To review outcomes of spinopelvic dissociation treated with open lumbopelvic fixation. METHODS: We reviewed all cases of spinopelvic dissociation treated at three Level-I trauma centers with open lumbopelvic fixation, including those with adjunctive percutaneous fixation. We collected demographic data, associated injuries, pre- and postoperative neurologic status, pre- and postoperative kyphosis, and Roy-Camille classification. Outcomes included presence of union, reoperation rates, and complications involving hardware or wound. RESULTS: From an initial cohort of 260 patients with spinopelvic dissociation, forty patients fulfilled inclusion criteria with a median follow-up of 351 days. Ten patients (25%) had a combination of percutaneous iliosacral and open lumbopelvic repair. Average pre- and postoperative kyphosis was 30 degrees and 26 degrees, respectively. Twenty patients (50%) had neurologic deficit preoperatively, and eight (20%) were unknown or unable to be assessed. All patients presenting with bowel or bladder dysfunction (n = 12) underwent laminectomy at time of surgery, with 3 patients (25%) having continued dysfunction at final follow-up. Surgical site infection occurred in four cases (10%) and wound complications in two (5%). All cases (100%) went on to union and five patients (13%) required hardware removal. CONCLUSION: Open lumbopelvic fixation resulted in a high union rate in the treatment of spinopelvic dissociation. Approximately 1 in 6 patients had a wound complication, the majority of which were surgical site infections. Bowel and bladder dysfunction at presentation were common with the majority of cases resolving by final follow-up when spinopelvic dissociation had been treated with decompression and stable fixation.
Subject(s)
Fracture Fixation, Internal , Lumbar Vertebrae , Humans , Male , Female , Adult , Middle Aged , Lumbar Vertebrae/surgery , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Spinal Fractures/surgery , Pelvic Bones/injuries , Pelvic Bones/surgery , Reoperation/statistics & numerical data , Retrospective Studies , Treatment Outcome , Kyphosis/surgery , Kyphosis/etiology , Postoperative Complications/etiology , Young Adult , Laminectomy/adverse effects , Laminectomy/methods , Surgical Wound Infection/etiology , AgedABSTRACT
Background/aim: Cervical spondylosis is a progressive disease that causes degenerative changes affecting the spine, intervertebral discs, facets, and ligaments. With anterior and posterior surgical interventions, effective treatments can be applied in cervical spondylotic myelopathy (CSM). The relationship between regional and global spinal alignment and functional and pain outcomes was examined and it was revealed that these parameters play a significant role in obtaining good results. The aim of this study was to compare the perioperative and follow-up results of patients with CSM who underwent laminoplasty or laminectomy with fusion. Materials and method: CSM patients who were operated on between 2015 and 2020 and had at least 2 years of clinical and radiological follow-up were analyzed retrospectively. The patients were divided into 2 groups as the laminoplasty group and the laminectomy with fusion group, according to a simple random method. Demographic, clinical, radiological, and perioperative parameters were examined. Measurements were made by an independent observer using Surgimap and 2 years was considered to be sufficient time for the spine to take its final shape. Result: A total of 112 patients, including 68 males and 44 females, were included. Of these patients, 69 were in the laminectomy with fusion group, and 43 were in the laminoplasty group. Patient ages ranged from 39 to 85 years. The mean follow-up period was 36.28 months. In both groups, at the 3-month follow-up, a statistically significant improvement in the clinical parameters (neck disability index, visual analogue scale, modified Japanese Orthopaedic Association scores) was observed. When the preoperative cervical radiological parameters were evaluated, no statistically significant difference was found between the groups. The C2-C7 lordotic angles and the cervical SVA values were increased in the postoperative period, for both groups (p < 0.001). Although it is noteworthy that the increases were higher in the laminectomy with fusion group, no statistically significant difference was found between the groups. Conclusion: Deformity in a spinal segment may indirectly affect another segment. Being aware of the compensatory mechanisms and radiological parameters will help in determining the effective treatment plan.