摘要:

A cadaveric study using the “funnel technique” to probe thoracic pedicles was conducted. The results (location, level, and perforation rate) of three spine surgeons of varying experience were compared. The objectives were to evaluate the reliability and accuracy of the funnel technique for the placement of thoracic pedicle screws and to describe the technique. Nine fresh cadavers (216 thoracic pedicles) were used for pedicle screw placement using the funnel technique. The study was conducted by three spine surgeons with a significantly different level of experience in thoracic pedicle screw placement (72 thoracic pedicles each). Critical and noncritical perforations were recorded. The perforation rate was 6% (13 of 216 pedicles). Of this, only 0.4% (1 of 216) was a critical perforation (a contact with T8 nerve root). The junior spine surgeon who had no previous experience with thoracic pedicle screw placement had a 12.5% (9 of 72) perforation rate, the surgeon very familiar with the technique had a 5.5% (4 of 72) perforation rate, and the senior author who originated this technique had a 1.4% (1 of 70) perforation rate. All perforations made by the junior spine surgeon occurred in his first 24 pedicles; none occurred in his last 48 pedicles. The reliability of the funnel technique in placement of thoracic pedicle screws was proven in our cadaveric study. It provided even an entry-level surgeon with a safe way to identify and place thoracic pedicle screws. The funnel technique is a simple, safe, and cost-effective alternative to any other currently recommended techniques for pedicle screw placement.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study is a retrospective review of the clinical results of patients treated with thoracic pedicle screws using the “funnel technique.” The objective is to report the clinical results of patients treated with thoracic pedicle screws using the funnel technique for screw placement. A total of 115 patients treated with the use of at least one thoracic pedicle screw were retrospectively identified. All patients were treated at a single medical center, under the senior author's supervision. Twenty-five different residents were responsible for placing 50–60% of these screws, and five different fellows and the senior author placed the remainder. The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing intraoperative and postoperative charts and radiographs. There were 115 patients (age range 9–82 years) with the average follow-up period of 17 months. The total number of screws used was 348; the screw diameter ranged from 4.0 to 7.75 mm. There were no vascular or pulmonary complications. There was no iatrogenic neurologic injury, except for one patient who developed a transient anterior thigh numbness from intraoperative positioning. In fracture patients, 35% (10 of 28) had documented neurologic improvement postoperatively. There were no obviously misplaced pedicle screws on detailed review of intraoperative and postoperative radiographs. No screws had to be electively removed for complications related to misplacement. There were four broken screws, one broken rod, two loose screws, and three connector disengagements. Two patients had deep infections and four patients had pseudarthrosis requiring additional surgery. The clinical results proved that thoracic pedicle screws can be safely placed with the funnel technique.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The objective of this study was to compare efficacy of cervical surgery for myelopathy in patients ≧70 and ≦60 years of age. Forty patients ≧70 years and 50 patients ≦60 years of age with MRI and CT proven myelopathy were neurologically assessed using the JOA score. Three operative procedures were performed: anterior spinal fusion, laminoplasty, and laminectomy. Postoperatively, patients exhibited comparable outcomes irrespective of age or operative procedure performed. The only exception was the increase in postoperative neurologic complications noted for the older individuals with greater comorbidities.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors used vertebroplasty for the treatment of severe lower lumbar radicular pain caused by osteoporotic compression fracture. Patients presented with severe radiating leg pain rather than lower back pain from recent osteoporotic compression fracture of lower lumbar vertebra. Radiologic findings showed osteoporotic compression fracture combined with preexisting stenosis of the intervertebral foramen resulting in root compression. After injection of polymethylmethacrylate into the compressed vertebral body through the pedicle of the symptomatic side, all seven patients experienced dramatic pain relief that lasted throughout the mean follow-up duration of 9.1 months. They conclude that vertebroplasty may be an effective way of relieving radicular pain caused by osteoporotic compression fracture combined with foraminal stenosis.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

In some lumbar disc herniation patients, noninvasive measures fail, necessitating more aggressive treatment, such as epidural steroid injections or surgery. This study sought to determine whether improvement in patients who receive epidural steroid injections is related to regression of herniated nucleus pulposus or whether such patients' symptoms decrease because of the steroid effect in the presence of continued herniated nucleus pulposus. Two nonoperatively treated patient cohorts were followed who had follow-up MRI. Specifically, 38 other patients who improved without invasive treatment within 6 weeks after the onset of their symptoms were compared with 20 patients who improved with epidural steroid injections. Results found that both groups had similar initial and follow-up herniated nucleus pulposus size and outcomes. The epidural steroid injection group had fewer sequestered or extruded herniations that resorbed, and most were of lower hydration. In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression. Patients in whom the disc herniation has less hydration may have prolonged symptoms, but many improve with epidural steroid injections.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The aim of this study is to evaluate the biomechanical effects of multilevel foraminotomy and foraminotomy with double-door laminoplasty compared with foraminotomy with laminectomy. Using fresh human cadaveric specimens (C2–T1), sequential injuries were created in the following order: intact, bilateral foraminotomies (C3–C4, C4–C5, C5–C6), laminoplasty (C3–C6) using hydroxyapatite spacer, removal of the spacers, and laminectomy. Changes in the rotations of each vertebra in each injury status were measured in six loading modes: flexion, extension, right and left lateral bending, and right and left axial rotation. Foraminotomy alone and following laminoplasty showed no significant differences in motion compared with intact except in axial rotation. After removal of the spacers and following laminectomy, the motion increased significantly in flexion and axial rotation. The ranges of initial slack showed similar trends when compared with the results at maximum load. Clinical implications of these observations are presented.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The removal of potentially painful lumbar pedicle screw implants is a recognized procedure not yet extensively reported in the literature. The extensive dissection required to accomplish it is such that this operation is generally done on an inpatient basis. A defined protocol of pre-, intra-, and postoperative care was instituted in the senior author's practice in 1995, with the goal of accomplishing these operations on a day-surgical basis. We report the results of 70 such procedures performed in the calendar years 1995–1999 with attention to the efficacy of the protocol in facilitating ambulatory care. The protocol is safe and effective.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Foot drop is a common and debilitating finding in patients with lumbar spinal disorders. Recovery of function after surgical treatment of the underlying disorder is not well documented in the literature. The purpose of this retrospective study was to analyze the prognosis of preoperative foot drop after lumbar surgery in 55 patients with foot drop and herniated nucleus pulposus and/or lumbar spinal stenosis. Preoperative dorsiflexion motor strength improved measurably in 98%, and 71% had full recovery of strength. All patients had associated neurologic findings and 71% experienced complete resolution. No statistically significant relationship was found between the extent of recovery and age, diagnosis (herniated nucleus pulposusvs.lumbar spinal stenosis), duration of symptoms, or severity of preoperative weakness. In our series, the prognosis of preoperative foot drop and associated neurologic deficits treated by lumbar spine surgery was excellent.

ISSN:1536-0652    

出版商:OVID    

年代:2002

数据来源: OVID