Direct Repair of Symptomatic Lumbar Spondylolysis Using Rod-Screw-Cable System.

OBJECTIVE: To assess the efficacy of a new direct lysis repair technique using internal fixation with rod, screws, and Songer cable in symptomatic lumbar spondylolysis. METHODS: Between December 2015 and January 2020, patients who were diagnosed with symptomatic lumbar spondylolysis and surgically treated with a rod-screw-cable system were recruited. Pedicle screwing by the Magerl technique was performed in all included patients, followed by direct lysis repair with bone allograft and demineralized bone matrix by stabilizing the posterior lamina and spinous process using a rod-screw-cable system. Clinical outcome was measured using the visual analog scale and Oswestry disability index preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS: Sixteen patients were included in this study-11 men and 5 women (mean age: 47 years; range, 26-67 years). The lytic defects were at L4 and L5 in 6 and 10 patients, respectively. The mean follow-up period was 41 months (24-62 months). The visual analog scale values were 7.3, 6.1, 4.3, 3.3, 2.1, and 1.9 preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively, respectively. The Oswestry disability index values were 59.8%, 55.4%, 41.7%, 32.4%, 21.1%, and 16.9% for the same periods, respectively. No patient had an increase in the slip after surgery. There were no significant complications such as implant failure. CONCLUSIONS: Our technique provides rigid intra-segmental repair of spondylolysis without intersegmental motion interference, even if the patient is older or has disc degeneration.

Effective cervical decompression by the posterior cervical foraminotomy without discectomy.

STUDY DESIGN: A retrospective review. OBJECTIVE: To compare the effectiveness of the posterior cervical foraminotomy (PCF) with and without discectomy for the treatment of cervical disk herniation. SUMMARY OF BACKGROUND DATA: Although PCF is effective and does not require a fusion procedure, it has certain disadvantages, including a narrow operating field, the need for cervical nerve root retraction, and the obstacle of epidural venous bleeding. Surgeons often find that these limitations complicate the removal of the disk material during PCF. METHODS: The study evaluated 135 consecutive patients who underwent PCF for cervical disk herniation and were followed up for a mean of 36.1 months. Of these patients, 117 were treated with posterior foraminotomy with discectomy (group A); the remaining 18 patients were treated with PCF alone because the disk could not be removed (group B). The clinical data, neurological status, radiologic findings, location of pathology, clinical outcomes, and postoperative satisfaction were compared between the 2 groups. RESULTS: The 2 groups had similar clinical outcomes. The mean visual analogue scale (VAS) score for radicular arm and neck pain improved from 7.8 and 5.7 to 4.6 and 3.6 in group A and from 6.6 and 6.2 to 3.4 and 3.6 in group B, and the mean Oswestry disability index (ODI) score from 39.6 and 38.7 to 23.2 and 17.6 in groups A and B, respectively. The success rates in groups A and B were 90.6% and 88.8%, respectively. Radiologic examination found significant differences in operative-level disk softness and disk type between the groups (P<0.05). Protruding, mixed-type, and C4-5 level were more difficult to remove and required more extensive foraminal unroofing. CONCLUSIONS: Despite the surgical and anatomic limitations, PCF with or without discectomy is an effective treatment for cervical disk herniation.

Laser-assisted posterior cervical foraminotomy and discectomy for lateral and foraminal cervical disc herniation.

OBJECTIVE: Posterior cervical foraminotomy and discectomy (PCFD) is regarded as an effective treatment option for cervical radiculopathy. However, limited exposure of the disc space is one of its major disadvantages. To address this problem, we used a CO(2) laser for sophisticated decompression. The purpose of this study was to demonstrate the clinical outcomes of laser-assisted PCFD and to discuss the benefits of laser use. METHODS: A total of 47 consecutive patients with cervical radiculopathy were treated with PCFD. Among them, 24 patients were treated with laser-assisted PCFD, and the remaining 23 patients were treated with conventional PCFD. After standard posterior cervical microscopic foraminotomy, a microscopic CO(2) laser was used for selective discectomy in the laser PCFD group. Clinical data were compared with a minimum 2-year follow-up period. Clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified MacNab criteria. RESULTS: The clinical outcomes of the two groups were similar. The mean VAS score for radicular arm pain improved from 7.42 to 1.83 in the laser PCFD group and from 8.30 to 1.65 in the conventional PCFD group. The mean NDI improved from 47.00% to 10.46% in the laser PCFD group and from 53.86% to 10.02% in the conventional PCFD group. The rate of excellent or good outcomes was 87.5% for the laser PCFD group and 86.9% for the conventional PCFD group. A significant difference between the groups was found for intraoperative bleeding. The laser PCFD group had significantly lower estimated blood loss values than did the conventional PCFD group (p<0.05). CONCLUSIONS: Laser-assisted PCFD is an efficacious surgical option for treating lateral cervical disc herniation. The pinpoint accuracy of the laser scalpel facilitates sophisticated decompression within a limited surgical field, and may reduce the risk of intraoperative bleeding and neural damage.