Comparison of Anterior Cervical Foraminotomy and Posterior Cervical Foraminotomy for Treating Single Level Unilateral Cervical Radiculopathy.

STUDY DESIGN: Retrospective study. OBJECTIVE: To compare clinical and radiological outcomes after two surgical procedures. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion is the gold standard treatment for cervical radiculopathy. Cervical foraminotomy is an alternative decompressive treatment option to preserve segmental motion and avoid fusion-related complications. Anterior cervical foraminotomy (ACF) and posterior cervical foraminotmy (PCF) has been introduced to achieve foraminal decompression. The objective of this study was to compare long-term clinical and radiological outcomes after two surgical procedures for the treatment of single-level cervical radiculopathy. METHODS: A retrospective review of patients undergoing ACF or PCF for the treatment of single-level unilateral cervical radiculopathy from 2010 to 2012 was performed. Demographic, perioperative, and clinical outcomes of 40 patients for each group were collected from the electronic medical records. Clinical outcomes were assessed by visual analog scores, while disc height (DH), cervical lordosis (CL), and C2-7 sagittal vertical axis (C2-7 SVA) data were obtained from pre- and postoperative radiography data. RESULTS: Both groups showed similar clinical improvements after surgery. Radiographically, the ACF groups showed profound decrease in DH only at the first month after surgery, and there was no significant change in DH after 1 year. The PCF group showed no significant changes in DH at follow-up. With respect to CL, ACF showed a significant decrease. There was no statistically significant change in C2-7 SVA before or after surgery in both groups. CONCLUSION: Both ACF and PCF showed significant clinical improvement of radiculopathy. In the ACF group, the DH decreased, and CL decreased during the early postoperative period. Radiological parameters were preserved in the PCF group after surgery. However, this group showed greater intraoperative bleeding and revision rates. Care should be taken to manage complications according to the specific surgical treatment. LEVEL OF EVIDENCE: 3.

Influence of a Preoperative Conference on Surgeons' Decision-making for Adult Spinal Disorders: A Prospective Clinical Study From a Spine Hospital.

STUDY DESIGN: This was a prospective clinical study. OBJECTIVE: The aim of this study was to evaluate the influence of a preoperative conference on spine surgeons' decision-making in the treatment of adult spinal disorders. SUMMARY AND BACKGROUND DATA: There are several factors that spine surgeons have to consider when determining a surgical plan for the treatment of spinal disorders, which include surgical approach, application of fusion or nonfusion surgery, levels to be treated, treatment of accompanying spinal conditions, the need for further preoperative imaging, and the implant type to be used. MATERIALS AND METHODS: A consecutive series of patients with a variety of adult spinal disorders at a single spine hospital were analyzed. The imaging modalities and clinical examination history of these patients were presented at a daily preoperative conference attended by staff spine surgeons and spine surgery fellows at this spine hospital. The specific surgical plan before the preoperative conference and before the surgery were compared for each patient. RESULTS: A total of 506 consecutive patients were reviewed over a 4-month period. Changes in the surgical plan following the preoperative conference occurred in 29 cases (5.7%). Seventeen of these changes were minor modifications in the same surgical level, or inclusion/exclusion of adjacent or other levels in the surgical plan, without changing the planned surgical approach. The surgical approach changed in a total of 12 cases (2.3%). Statistical analysis showed that the surgeons with experience of <10 years and orthopedic surgeons changed their surgical plan more often after the preoperative conference (P<0.05). CONCLUSIONS: Preoperative conference for the surgical treatment of adult spinal disorders influenced the surgical plan in 5.7% of surgeries. This type of daily preoperative conference seems to have only a minor impact on spine surgeons' decision-making, but, instead, it could be used to provide training and insight to better a fellow or resident's education at the spine institution. LEVEL OF EVIDENCE: Level IV.

Three cases of L4-5 Baastrup's disease due to L5-S1 spondylolytic spondylolisthesis.

PURPOSE: Baastrup's disease is characterized by degeneration of spinous processes and interspinous soft tissue, which may cause spinal stenosis. Purpose of this article is to report the possible new cause of Baastrup's disease and result of surgical treatments. METHODS: Authors treated three cases of Baastrup's disease on L4-L5 with L5-S1 spondylolytic listhesis. Conservative treatment did not relieve the pain; therefore, surgical treatments were planned according to each specific disease condition. RESULTS: In one case, anterior lumbar interbody fusion of L5-S1 was performed, and after surgery, the size of epidural cyst on L4-L5 was decreased. L4-L5 bilateral laminectomy was performed to directly decompress posterior epidural cyst in a case with stable L5-S1 spondylolytic listhesis. In last case, facet joints and spinous process were removed by L5-S1 posterior lumbar interbody fusion (PLIF) surgery. After the surgery, patients' back and leg pain was improved and postoperative MRI revealed successful decompression of the spinal canal. Improvement in back and leg symptoms was noted at 12-month follow-up. CONCLUSIONS: Baastrup's disease at the L4-L5 level may have developed from the instability caused by L5-S1 spondylolytic spondylolisthesis. Viable treatment options include the fusion of L5-S1 or a laminectomy at the L4-L5 level.

Radiological analysis of upper lumbar disc herniation and spinopelvic sagittal alignment.

PURPOSE: A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development. METHODS: A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups. RESULTS: There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups. CONCLUSIONS: This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.

Risk factors for delirium after spine surgery in elderly patients.

OBJECTIVE: Postoperative delirium is a common complication in the elderly after surgery but few papers have reported after spinal surgery. We analyzed various risk factors for postoperative delirium after spine surgery. METHODS: Between May 2012 and September 2013, 70 patients over 60 years of age were examined. The patients were divided into two groups : Group A with delirium and Group B without delirium. Cognitive function was examined with the Mini-Mental State Examination-Korea (MMSE-K), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Information was also obtained on the patients' education level, underlying diseases, duration of hospital stay and laboratory findings. Intraoperative assessment included Bispectral index (BIS), type of surgery or anesthesia, blood pressure, fluid balance, estimated blood loss and duration of surgery. RESULTS: Postoperative delirium developed in 17 patients. The preoperative scores for the MMSE, CDR, and GDS in Group A were 19.1±5.4, 0.9±0.6, and 3.3±1.1. These were significantly lower than those of Group B (25.6±3.4, 0.5±0.2, and 2.1±0.7) (p<0.05). BIS was lower in Group A (30.2±6.8 compared to 35.4±5.6 in group B) (p<0.05). The number of BIS <40 were 5.1±3.1 times in Group A, 2.5±2.2 times in Group B (p<0.01). In addition, longer operation time and longer hospital stay were risk factors. CONCLUSION: Precise analysis of risk factors for postoperative delirium seems to be more important in spinal surgery because the surgery is not usually expected to have an effect on brain function. Although no risk factors specific to spinal surgery were identified, the BIS may represent a valuable new intraoperative predictor of the risk of delirium.

Improved electrical performance and bias stability of solution-processed active bilayer structure of indium zinc oxide based TFT.

We fabricated active single- and bilayer structure thin film transistors (TFTs) with aluminum or gallium doped (IZO:Al or IZO:Ga) and undoped indium zinc oxide (IZO) thin film layers using an aqueous solution process. The electrical performance and bias stability of these active single- and bilayer structure TFTs were investigated and compared to reveal the effects of Al/Gal doping and bilayer structure. The single-layer structure IZO TFT shows a high mobility of 19 cm(2)/V · s with a poor positive bias stability (PBS) of ΔVT + 3.4 V. However, Al/Ga doped in IZO TFT reduced mobility to 8.5-9.9 cm(2)/V · s but improved PBS to ΔVT + 1.6-1.7 V due to the reduction of oxygen vacancy. Thus, it is found the bilayer structure TFTs with a combination of bottom- and top-layer compositions modify both the mobility and bias stability of the TFTs to be optimized. The bilayer structure TFT with an IZO:X bottom layer possess high mobility and an IZO bottom layer improves the PBS.

Multiple spontaneous simultaneous intracerebral hemorrhages.

Simultaneous occurrence of intracerebral hemorrhage (ICH) in different arterial territories is an uncommon event. We report on two cases of multiple spontaneous simultaneous ICH for which we could find no specific cause. A 73-year-old man, with no related medical history, was admitted to the hospital with simultaneous bithalamic ICH, and subsequently died of recurrent pneumonia. Second patient was a 60-year-old man who presented with simultaneous ICH in the pons and thalamus; he died of recurrent bleeding. We review the possible pathological mechanisms, clinical and radiologic features of simultaneous multiple ICH.

Solution-processed flexible fluorine-doped indium zinc oxide thin-film transistors fabricated on plastic film at low temperature.

Transparent flexible fluorine-doped indium zinc oxide (IZO:F) thin-film transistors (TFTs) were demonstrated using the spin-coating method of the metal fluoride precursor aqueous solution with annealing at 200°C for 2 hrs on polyethylene naphthalate films. The proposed thermal evolution mechanism of metal fluoride aqueous precursor solution examined by thermogravimetric analysis and Raman spectroscopy can easily explain oxide formation. The chemical composition analysed by XPS confirms that the fluorine was doped in the thin films annealed below 250°C. In the IZO:F thin films, a doped fluorine atom substitutes for an oxygen atom generating a free electron or occupies an oxygen vacancy site eliminating an electron trap site. These dual roles of the doped fluorine can enhance the mobility and improve the gate bias stability of the TFTs. Therefore, the transparent flexible IZO:F TFT shows a high mobility of up to 4.1 cm(2)/V·s and stable characteristics under the various gate bias and temperature stresses.