Resection of a large spinal intradural ependymoma using a limited unilateral laminectomy approach in the lumbosacral region.

Ependymomas are the most common gliomas of the lower spinal cord, conus medullaris and filum terminale. Although there are several surgical modalities indicated in the removal of spinal tumors, total laminectomy is the conventional method used. However, surgical complications, such as spinal deformities and instability are more common with this approach compared to limited unilateral hemilaminectomy. To present the clinical and radiologic results of patient with a large spinal intradural ependymoma via a limited posterior unilateral laminectomy approach in the lumbosacral region. The aim of this study was to present a modified duramater incisions and surgical positions setup, and discussed the major controversies in treatment in the literature. This article reports the surgical resection of a lumbosacrally localized ependymoma in a 25-year-old male patient using unilateral laminectomy at the L4 to S3 levels. The tumor was removed with any difficulty in reaching to contralateral side. A follow-up lumbar magnetic resonance imaging scan with and without contrast performed 18 months postoperatively showed no residual or recurrent tumor lesions. This procedure may be more difficult than the conventional total laminectomy as suturing of the duramater. However, modified duramater incisions and setup of microscope-operating table provides best facilitates to surgery manipulation. Besides, unilateral limited laminectomy protected the posterior supporting elements. In order to reduce the postoperative complications and minimize the destruction of tissue, unilateral limited hemilaminectomy is recommended for the removal of intradural tumors. This technique facilitates the return of the patient to ordinary life.

Thoracoscopic surgery for thoracic disc herniation.

Technical improvements in endoscopy have had a major effect in the practice of minimally invasive surgery, which is preferable to more invasive surgical procedures for central and hard thoracic disc herniation. Eleven patients underwent surgery between 2002 and 2008. Data was collected from self-reporting questionnaires completed by the patient at each visit before surgery and after surgery at 3,6,12 and 24 months. The questionnaires included in the study were the Oswestry Disability Questionnaire and a visual analog scale(VAS) for the evaluation of pain. In all eleven patients, the thoracoscopic approach was technically performed satisfactorily. There was a significant initial improvement in both the Oswestry score and the VAS pain score at up to nine months(P<0.05). The average relative difference in the Oswestry and VAS score was not significant at 12 and 24 months. The complication rate(pleurisy and lung contusion) in our small study was 18%, which compares favorably with the literature. Video assisted thoracic spine surgery (VATS) clearly provides a minimally invasive and effective alternative to open thoracic surgery. A surgeon must be familiar with the surgical anatomy and the endoscopic techniques to ensure an optimal surgical outcome. Hence, that is one limitation in the practice of thoracoscopic discectomy.

Posterior dynamic stabilization in the treatment of lumbar degenerative disc disease: 2-year follow-up.

BACKGROUND: A prospective pilot study was designed to evaluate the role of a posterior dynamic stabilization technique in the surgical treatment of degenerative disc disease. Posterior dynamic stabilization with a hinged screw is a new concept in the surgical treatment of degenerative disc disease of the lumbar spine. The traditional surgical treatment is to apply a fusion procedure. However, numerous reports showed unsatisfactory clinical outcomes even when patients have satisfactory radiological outcomes following fusion procedures. MATERIAL AND METHODS: The study included patients who were surgically treated with a dynamic stabilization technique due to painful degenerative disc disease. Clinical and radiological findings for the 20 participating patients were analyzed in a 2-year follow-up study. Preoperative and postoperative data at the 3 (rd), 12 (th) and 24 (th) month were collected for both clinical and radiological outcomes. Statistical analyses between preoperative and postoperative data were performed using the Wilcoxon test. RESULTS: The clinical outcome measurements (VAS, ODI) showed significant improvement in all postoperative measurements compared to preoperative values. The mean preoperative visual analogue score (VAS, 7.9) and Oswestry Disability Index (ODI 59.2) significantly decreased to 0.8 for VAS and 9.2 for ODI, at 2 years post-operation (p<0.05). The radiological studies showed no significant changes between pre- and postoperative values, in all parameters. There was no mortality or morbidity. CONCLUSIONS: The results of this pilot study are encouraging. Dynamic stabilization may be an effective technique in the surgical treatment of painful degenerative disc disease. A larger series study, with longer follow-up periods and with control groups is needed to determine the success and safety of posterior dynamic stabilization in the surgical treatment of degenerative disc disease.

Pedicle screw-based posterior dynamic stabilisation of the lumbar spine: in vitro cadaver investigation and a finite element study.

Pedicle screw-based dynamic constructs either benefit from a dynamic (flexible) interconnecting rod or a dynamic (hinged) screw. Both types of systems have been reported in the literature. However, reports where the dynamic system is composed of two dynamic components, i.e. a dynamic (hinged) screw and a dynamic rod, are sparse. In this study, the biomechanical characteristics of a novel pedicle screw-based dynamic stabilisation system were investigated and compared with equivalent rigid and semi-rigid systems using in vitro testing and finite element modelling analysis. All stabilisation systems restored stability after decompression. A significant decrease in the range of motion was observed for the rigid system in all loadings. In the semi-rigid construct the range of motion was significantly less than the intact in extension, lateral bending and axial rotation loadings. There were no significant differences in motion between the intact spine and the spine treated with the dynamic system (P>0.05). The peak stress in screws was decreased when the stabilisation construct was equipped with dynamic rod and/or dynamic screws.