Mean 5-Year Follow-Up Results of a Facet Replacement Device in the Treatment of Lumbar Spinal Stenosis and Degenerative Spondylolisthesis.

OBJECTIVE: Flexible stabilization has been utilized to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any nonfusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean 5-year outcomes of patients treated with the Total Posterior Spine System (TOPS) facet replacement system in the surgical management of lumbar spinal stenosis and degenerative spondylolisthesis. METHODS: Ten patients (2 men, 8 women, mean age: 59.6 years) were enrolled into a non-randomized prospective clinical study. Patients were evaluated with standing anteroposterior, lateral, flexion and extension radiographs and magnetic resonance imaging scans, back and leg pain visual analog scale scores, Oswestry Disability Index, Zurich Claudication Questionnaire and the SF-36 questionnaires, preoperatively, 6 months, 1 year, 2 years, and latest follow-up at a mean of 5 years postoperatively (range: 55-74 months). Flexion and extension standing lumbar spine radiographs were obtained at 2 years to assess range of motion at the stabilized segment. RESULTS: The clinical outcome scores for the cohort improved significantly across all scoring systems. Radiographs at 2 years did not reveal any loss of position or loosening of metal work. There were 2 incidental durotomies and no failures at 5 years, with no patient requiring revision surgery. CONCLUSIONS: The TOPS implant maintains clinical improvement and motion in the surgical management of LSS and spondylolisthesis, suggesting that it can be considered an option for these indications.

Vertebral artery dissection presenting with multilevel combined sensorimotor radiculopathy: a case report and literature review.

STUDY DESIGN: This study is a case report demonstrating a rare clinical presentation of vertebral artery dissection. We believe that this is the first reported case with multilevel combined sensorimotor radiculopathy. We have also included a literature review. OBJECTIVE: The purpose of this report is to inform the reader of a unique clinical presentation and to draw attention to some of the rare features of extracranial vertebral artery dissection. We believe that this condition is perhaps underrecognized and this paper may help to increase awareness, thereby encouraging prompt investigation, diagnosis, and implementing early treatment. The literature review also includes a brief anatomic and physiologic description of the underlying pathologic process. SUMMARY OF BACKGROUND DATA: Only a small number of similar cases are described in the literature, though most describe a motor deficit at a single root level. Our case included both motor and sensory deficits at more than 1 level and we describe the possible physiologic and anatomic reasons for this. METHODS: The case described is one that presented to our institution and was initially assessed by the first (corresponding) author. The literature review is based on articles identified from a PubMed search on vertebral artery dissection. RESULTS: The clinical and radiologic findings are discussed in the case report. CONCLUSIONS: Peripheral motor deficits are a rare clinical presentation of spontaneous vertebral artery dissection and tend to affect a solitary root level, typically C5. Sensation is usually preserved. We describe a case presenting with multilevel combined sensorimotor radiculopathy, which we believe has not previously been reported.