ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We have modified the operative procedure of laminoplasty and changed the postoperative therapy since 1997. In the modified group, several modifications were incorporated. The open door type of cervical en bloc laminoplasty was performed. 1) Bone grafts in the open gap were placed at three levels only. 2) Bone grafting in the hinged side was not performed. 3) The neck collar was worn for only 1 month. 4) The doctors explained the importance of the neck muscle and advised patients to perform early exercise of the posterior neck muscle. The patients who had the original operation and postoperative therapy served as the control (control group). The original operation and postoperative therapy were as follows: Bone grafts from dissected spinous processes were put in the opened laminae and fixed with braided wires or nylon threads. Bone grafts in the open gap were placed to extend from three to five levels. Bone chips were also placed in the hinged side. The orthosis was applied for up to 1 months after surgery, and a neck collar was recommended for 1 additional month. Postoperative neurologic recovery and axial symptoms after cervical laminoplasty were compared between the two groups. There was no statistical difference in postoperative neurologic recovery. However, the incidence of axial symptoms was much lower in the modified group compared with the control group. Radiologic examination showed that postoperative range of motion of the cervical spine in the modified group was significantly well preserved and the number of postoperative fused laminae in the modified group was less than that in the control group. Based on these results, we concluded that the modified method is beneficial for the postoperative status of cervical laminoplasty patients.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Few data are available to evaluate approach-related differences in perioperative complications with lumbar interbody fusion devices. Complications occurring in the intraoperative and immediate postoperative period were identified and categorized for 31 consecutive posterior lumbar interbody fusions (PLIFs) and 88 consecutive anterior lumbar interbody fusions (ALIFs). In this study, all lumbar interbody fusions were conducted with threaded cylindrical devices as stand-alone internal fixation devices. Multivariate analysis was used to account for potential covariates and identify factors associated with an increased complication risk. Twenty-two percent of the patients had a perioperative complication. The relative risk of having a perioperative complication was 4.75 times higher for the PLIF group. All intraoperative complications occurred in the PLIF group. The relative risk of having a major postoperative complication was 6.8 times higher in the PLIF group than the ALIF group. Anterior approached patients tended to have visceral (ileus, 6%) and vascular (deep venous thrombosis, 2%) complications. In the posterior group, complications were neurologic and dura related (pseudomeningocele, 16%; epidural hematoma, 3%) and occurred most frequently in patients that had had previous posterior lumbar surgery (31% with major complication).

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe purpose of this prospective study was to assess the impact of closed suction drainage on transfusion requirements, frequency of dressing changes, and wound healing following posterior spinal fusion in adolescents with idiopathic scoliosis.MethodsThirty patients were randomly assigned to one of two groups: drain or no drain. Although the group with drains received more postoperative autologous blood transfusions than the group with no drains (0.88 vs 0.5 unit), the difference was not statistically significant (P= 0.2131). In the undrained group, 58% of the patients had moderate to completely saturated dressings on the second postoperative day compared with only 17% of patients in the drained group. Three of 12 patients in the undrained group demonstrated a wound complication rate compared with no complications in the drained group.ConclusionIn conclusion, subcutaneous closed suction drainage can improve immediate postoperative wound care without significantly increasing blood loss and transfusion requirements for patients undergoing surgery for idiopathic scoliosis.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cervical fusion cages have been developed to provide an anterior structural support without harvesting tricortical iliac bone. Limited numbers of investigations have focused on pitfalls of anterior cervical fusion using cage implants. The objective of this study is to report clinical results and implant-related complications in anterior cervical fusion using titanium mesh and anterior plating. Twenty-four cases with anterior cervical fusion using a titanium mesh with local autograft and anterior plating were reviewed. One-level fusion was performed in 7 cases, and 17 patients underwent two-level fusion with corpectomy. The mean follow-up period was 27 months. Radiographic assessment included sagittal alignment, fusion status, and complications related to cage implants. Iliac bone graft harvesting was obviated in all the patients, whereas 15 patients required concomitant use of ceramic bone substitute. Sagittal alignment of the operative level was lordotic in 19 cases (79%) and neutral in 5 cases (21%) at the final follow-up. No late kyphotic collapse was observed. Twenty-three cases (96%) achieved a solid fusion, whereas the time to fusion was averaged 6.2 months. Cage subsidence frequently occurred in 42% of upper vertebrae and 50% of lower vertebrae. The use of titanium mesh and local autograft for anterior cervical fusion obviated the need for harvesting iliac bone block and provided structural anterior column support. However, it required a longer period to achieve a solid fusion when compared with tricortical iliac autograft. Cage subsidence was frequently observed in the early postoperative period.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors describe a case of a 67-year-old man who presented with a delayed esophageal perforation 4 years after anterior cervical spine surgery for spondylotic myelopathy. Diagnosis was made with esophagoscopic visualization of the lesion and repair performed with hardware removal and esophageal closure utilizing a sternocleidomastoid muscle flap. The pertinent literature is reviewed and the therapeutic implications discussed.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Acute traumatic L5–S1 spondylolisthesis is a rare condition, almost exclusively the result of major trauma, frequently associated with L5 transverse process fracture and neurologic deficit. In recent years, open reduction and internal fixation with posterior stabilization has been the method of treatment most frequently reported. In the current case, the lesion was found in a victim of an automobile accident. Signs of a right L5 root deficit but no sphincter dysfunction were present. A computed tomography scan revealed several fractures in the posterior parts of L5 and anterior displacement of L5 on S1. A magnetic resonance imaging (MRI) scan verified that the lesion was indeed acute by showing the ruptured L5 disc and posterior ligaments, thereby demonstrating the importance of MRI in the planning of the treatment of these lesions. This case was successfully treated with an acute circumferential instrumented L4–S1 spondylodesis.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors describe techniques and preliminary results of two releasing procedures for idiopathic scoliosis, which can be performed concomitantly in the same stage of posterior instrumentation surgery. The transpedicular microscopic discectomy and transverse process resection were clinically applied for adolescent idiopathic scoliosis. Twelve patients were divided into three groups at random: Group A patients underwent no release, group B patients underwent transverse process resection, and group C patients underwent microscopic discectomy of three discs and transverse process resection, in combination. All patients were operated on with derotation procedure with Cotrel-Dubousset instrumentation simultaneously after each releasing procedure. The outcomes—curve correction, disc wedge angle, and rotational changes—were evaluated 12 months postoperatively. The mean correction rate of the Cobb angle in group C (78%) was higher than in groups A (54%) and B (64%). Correction of the disc wedge angle was also higher in group C compared with groups A and B. The authors conclude that microscopic discectomy appeared to be an effective releasing method for thoracic curve and that further investigation is necessary for accurate evaluation of the transverse process resection.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The first anatomic description of extraforaminal herniation found in the literature was published in 1944. This was followed by several definitions regarding the anatomic site of this pathology. We consider correct the definition of lumbar extraforaminal herniation concerning the anatomic site of the herniated fragment. This fragment compresses the nervous root after its exit from the foramen, thus causing the compression of the spinal ganglion against the strong intertransverse ligament. The incidence of the pathology shifts from 1% to 12% and in our study was 4.2%. Over these years, the surgical approach has changed mainly because of two requirements: good exposition both of the foramen and of the herniation and the necessity of preserving stability of the spinal column as much as possible. In the last 30 years, less invasive approaches, paramedian, para- and transmuscular, lateral, and tangential, have been preferred to an interlaminar medial approach with a subtotal and/or complete facetectomy. In the last 4 years, 46 patients presenting with pure extraforaminal herniation have been treated in our institute through a far lateral microsurgical approach, avoiding resection of bone and reducing to the minimum the muscular retraction and the closure of blood vessels. We advocate a far lateral microsurgical approach, with no resection of bone and with highest respect for the osseous articular and muscular structures.

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1536-0652    

出版商:OVID    

年代:2003

数据来源: OVID