Can cantilever transforaminal lumbar interbody fusion (C-TLIF) maintain segmental lordosis for degenerative spondylolisthesis on a long-term basis?

PURPOSE: To determine if cantilever transforaminal lumbar interbody fusion (C-TLIF) using the crescent-shaped titanium interbody spacer (IBS) favors acquisition of segmental and lumbar lordosis even for degenerative spondylolisthesis (DS) on a long-term basis. METHODS: We analyzed 23 consecutive patients who underwent C-TLIF with pedicle screw instrumentations fixed with compression for a single-level DS. Measurements on the lateral radiographs taken preoperatively, 2 weeks postoperatively and at final follow-up included disc angle (DA), segmental angle (SA), lumbar lordosis (LL), disc height (%DH) and slip rate (%slip). RESULTS: There was a good functional recovery with 100 % fusion rate at the mean follow-up of 62 months. Segmental lordosis (DA and SA) and %DH initially increased, but subsequently decreased with the subsidence of the interbody spacer, resulting in a significant increase (p = 0.046) only in SA from 13.2° ± 5.5° preoperatively to 14.7° ± 6.4° at the final follow-up. Changes of LL and %slip were more consistent without correction loss finally showing an increase of LL by 3.6° (p = 0.005) and a slip reduction by 6.7 % (p < 0.001). CONCLUSIONS: Despite the inherent limitation of placing the IBS against the anterior endplate of the upper vertebra in the presence of DS, the C-TLIF helped significantly restore segmental as well as lumbar lordosis on a long-term basis, which would be of benefit in preventing hypolordosis-induced back pain and the adjacent level disc disease.

Thoracic Radicular Pain Caused by Extravertebral Gas and Fluid Collections Associated with Osteoporotic Vertebral Fracture Containing a Vacuum Cleft.

The present study documents a phenomenon, which has received little attention despite its potential clinical importance. An 87-year-old woman presented with barely reported extravertebral gas and fluid collections probably originating from the contents of the adjacent cleft within the T10 collapsed osteoporotic vertebra. Her chief complaint was intractable pain radiating over the left thorax suggestive of intercostal neuralgia. The pain intensified when sitting up from a lateral decubitus position, correlating with a posture-related radiologic change of the intravertebral cleft, which appeared with a decubitus position and disappeared with a sitting position. Because these extravertebral collections were located where the 10th thoracic nerve root just exits the intervertebral foramina, her chest pain of a posture-dependent nature most likely resulted from nerve root compression by extravertebral gas and fluid forced out of the vertebral cleft. Posterior spinal fusion with pedicle screw instrumentation resulted in a complete resolution of the chest pain with disappearance of the extravertebral gas and fluid accumulations. An awareness of the possibility that the intravertebral cleft could communicate with the extravertebral space close to the nerve root will help avoid neurologic complications caused by bone cement leakage during vertebroplasty.

A Recurrent Cervical Neurenteric Cyst Treated Anteriorly: Safe, Gross-Total Excision Facilitated by Prophylactic Unilateral Vertebral Artery Exposure, Microdissection, and Spinal Cord Monitoring-A Case Report and Technical Note.

This study reports on a 67-year-old woman with partial Brown-Séquard syndrome due to a recurrent cervical neurenteric cyst at C3 to C4. The myelopathic symptoms reappeared 22 years after a previous shunting operation performed posteriorly with a silicone tube connecting the intradural cervical cyst cavity to the subarachnoid space. We have now succeeded in removing the cyst nearly completely with the anterior approach. The surgical procedure consisted of right vertebral artery exposure at C3 and C4 and a subtotal corpectomy of C3 followed by microdissection of the cyst, duraplasty, and iliac strut graft fusion. Spinal cord monitoring with motor-evoked potential studies helped us safely dissect the cyst wall tightly adhering to the spinal cord. Duraplasty with Gore-Tex patch-grafting in conjunction with postoperative lumbar subarachnoid drainage worked well in preventing a spinal fluid fistula. At two years after surgery, the patient showed a nearly complete return of function without any recurrence of the cyst.

Recovery of muscle strength after high tibial osteotomy.

To assess muscle strength after high tibial osteotomy (HTO) using percutaneous drilling, we prospectively evaluated the isometric and isokinetic muscle torque of the thigh before operation and after operation over time. We evaluated 27 joints of 26 patients with a mean age of 66 years. The muscle torque/weight ratio was seen to decrease, and the hamstrings/quadriceps (H/Q) ratio increased at 3 months after HTO; both ratios showed no significant difference at 6 months. Improved muscle strength appeared at isometric extensor of 50 degrees, not 80 degrees, and at slow isokinetic speeds of 30 degrees /s, not 90 degrees /s. There was no significant difference in terms of the age of patients regarding the recovery of muscle strength. We also compared patients with a varus angle of >/=5 degrees and those with a varus angle <5 degrees before the operation. In terms of extension, the group with varus angles <5 degrees showed a greater postoperative increase in isometric torque at 80 degrees flexion of the knee and isokinetic torque at 90 degrees /s than did the group with varus angles of >/=5 degrees.

Mechanism of combined injuries of the posterior cruciate ligament and the posterolateral ligament while wake boarding.

BACKGROUND: We encountered a case involving posterior cruciate ligament (PCL) and posterolateral ligament injuries of the knee due to a noncontact injury while wake boarding. The moment of injury was recorded on a home video. CASE REPORT: Based on our analysis of the video, the mechanism of injury was considered to be a combination of varus stress and internal rotation of the lower leg that induced tearing of the posterolateral ligaments. Subsequently, tearing of the PCL in the midsubstance occurred due to increased flexion of the knee.