Search PubMed⌕ Search

Biomedical subjects

William C Welch

Publications and source records attributed to William C Welch.

36 records · Page 2Linked to original sources
PubMed2004

Far-lateral disk herniation: case report, review of the literature, and a description of nonsurgical management.

OBJECTIVE: To review the history and examination of a far-lateral lumbar intervertebral disk herniation (FLLIDH), as well as the treatment and outcomes of a nonsurgical approach. CLINICAL FEATURES: A 60-year-old healthy male subject had a 3-week history of right buttock and calf pain. He initially had a left lateral list and asymmetrical pelvic landmarks. Range of motion (ROM) of the lumbar spine revealed full and pain-free lumbar flexion, right-sided pain with lumbar extension and left side bending, and painful and restricted left side bending. Neurologic examination was unremarkable. INTERVENTION AND OUTCOME: The patient was treated with a lumbar epidural and nerve root injection, as well as manipulation. Physical therapy consisted of deweighting treadmill, autotraction, and strengthening exercises. Outcomes were measured by using the Modified Oswestry Questionnaire, as well as a numerical pain rating scale. His initial Oswestry was 73%, pain 9/10 at presentation. Upon discharge, the Oswestry was 0% and pain was rated as 0/10. CONCLUSION: A significant decrease was noted in both the Oswestry Questionnaire, as well as the pain rate. The patient returned to running on alternate days for a minimum of 30 minutes, which was his primary goal. This case demonstrated a positive outcome using a multidisciplinary approach in a patient diagnosed with a FLLIDH. He obtained his goals and his function was fully restored.

Humans↗
PubMed2004

Cyberknife radiosurgery for metastatic spine tumors.

Metastatic spine tumors affect a large number of patients each year, resulting in significant pain,destruction of the spinal column causing mechanical instability, and neurologic deficits. Standard therapeutic options include surgery and fractionated external beam radiotherapy. The first option can be associated with significant morbidity and limited local tumor control. Conversely, radiotherapy may provide less than optimal pain relief and tumor control, because the total dose is limited by the tolerance of adjacent tissues, such as the spinal cord. The emerging technique of spinal radiosurgery represents a logical extension of the current state-of-the-art radiation therapy. It has the potential to significantly improve local control of cancer of the spine, which could translate into more effective palliation and potentially longer survival. Spinal radiosurgery might offer improved pain control and a longer duration of pain control by giving larger radiobiologic doses.This technique also allows for the treatment of lesions previously irradiated using external beam radiation. Another advantage to the patient is that irradiation can be completed in a single day rather than several weeks, which is not inconsequential for patients with a limited life expectancy. In addition, cancer patients may have difficulty with access to a radiation treatment facility for prolonged daily fractionated therapy. This technique allows for the treatment of lesions previously irradiated using external beam radiation.Finally, the procedure is minimally invasive compared with open surgical techniques and can be performed in an outpatient setting. Similar to intracranial radiosurgery, stereo-tactic radiosurgery now has a feasible and safe delivery system available for the treatment of spinal metastatic lesions. The major potential benefit of radiosurgical ablation of spinal lesions is a relatively short treatment time in an outpatient setting combined with potentially better local control of the tumor with minimal risk of side effects. CyberKnife spinal radiosurgery offers a new and important alternative therapeutic modality for the treatment of spinal metastases in medically inoperable patients, previously irradiated sites, and for lesions not amenable to open surgical techniques or as an adjunct to surgery. Spinal radiosurgery is likely to become an essential part of any neurosurgical spine center that treats a large number of patients with spinal metastases.

Humans↗
PubMed2004

Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological disease.

OBJECT: Wound-related complications following complex posterior spine procedures may result in the need for serial debridements and may place the instrumentation at risk. Numerous treatments have been advocated for this problem, but each has limitations. In this article the authors discuss the experience from two large teaching institutions at which rotational and transpositional flaps were used in the management of deep wound infections and dehiscences. METHODS: The authors generated a list of patients treated via posterior or posterolateral approaches for metastatic tumors or complex degenerative disorders in whom wound complications subsequently developed. Data were obtained from the medical records and reviewed retrospectively. Thirty-seven patients were treated with rotational or transpositional flaps at the two institutions during the study period. Patients underwent a mean of 1.3 procedures for the treatment of wound healing problems, and cultures were positive in 70%. In three patients (8%) this treatment failed due to protrusion of hardware through the skin or repeated dehiscence requiring reclosure. Spinal instrumentation was salvaged in 97% of the cases. CONCLUSIONS: The use of local tissue flaps is advantageous for treatment of posterior wound complications due to spine surgery. In this procedure highly vascularized tissue is used to increase healing, accelerate clearance of bacteria, and fill any dead space.

Adolescent↗
PubMed2004

Effects of Tisseel fibrin glue on the central nervous system of nonhuman primates.

For many years, neurosurgeons and otolaryngologic surgeons have used the fibrin glue product Tisseel to repair skull-base spinal fluid leaks and to help secure repairs following anterior cranial-base surgery. Despite the widespread use, the potential focal cerebral toxicity of this fibrin glue has never been investigated. We studied the safety of Tisseel applied directly to neural tissue (brain parenchyma, cervical cord, and C3-C6 spinal roots) of 6 monkeys (Macaca nemestrina) to determine if any underlying biochemical injury would occur. Another 3 animals that served as controls received saline rather than Tisseel. We found that median nerve electroencephalographic tracings and somatosensory evoked potentials in the experimental and control animals were identical. Likewise, cerebrospinal fluid indicators of neuronal or brain injury, inflammatory responses, and infection were negative in both groups. Finally, there were no significant differences between the two groups with respect to edema volumes and apparent diffusion coefficient values. We conclude that Tisseel does not induce an apparent inflammatory response or abnormal neurophysiologic or histologic response within 5 days of its application when it is applied directly to the brain parenchyma or onto the cervical spinal cord.

Animal Experimentation↗
PubMed2004

CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases.

OBJECTIVE: The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. Conventional external beam radiotherapy lacks the precision to allow delivery of large doses of radiation near radiosensitive structures such as the spinal cord. The CyberKnife (Accuray, Inc., Sunnyvale, CA) is an image-guided frameless stereotactic radiosurgery system that allows for the radiosurgical treatment of spinal lesions. This study evaluated the feasibility and effectiveness of the treatment of spinal lesions with a single-fraction radiosurgical technique using the CyberKnife. METHODS: The CyberKnife system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator with six degrees of freedom that guides the therapy beam to the intended target without the use of frame-based fixation. Real-time imaging allows the tracking of patient movement. Cervical spine lesions were located and tracked relative to cranial bony landmarks; lower spinal lesions were tracked relative to fiducial bone markers. In this prospective cohort evaluation of a spine radiosurgery technique, 125 spinal lesions in 115 consecutive patients were treated with a single-fraction radiosurgery technique (45 cervical, 30 thoracic, 36 lumbar, and 14 sacral). There were 17 benign tumors and 108 metastatic lesions. All dose plans were calculated on the basis of computed tomographic images acquired from 1.25-mm slices with an inverse treatment planning technique. Radiosurgical circular cones ranging in diameter from 5 to 40 mm were used. RESULTS: Tumor volume ranged from 0.3 to 232 cm(3) (mean, 27.8 cm(3)). Seventy-eight lesions had received external beam irradiation previously. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean, 14 Gy); canal volume receiving more than 8 Gy ranged from 0.0 to 1.7 cm(3) (mean, 0.2 cm(3)). No acute radiation toxicity or new neurological deficits occurred during the follow-up period (range, 9-30 mo; median, 18 mo). Axial and radicular pain improved in 74 of 79 patients who were symptomatic before treatment. CONCLUSION: This is the first large prospective evaluation of this frameless image-guided spinal radiosurgery system. The CyberKnife system was found to be feasible, safe, and effective. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This technique offers a successful therapeutic modality for the treatment of a variety of spinal lesions as a primary treatment or for lesions not amenable to open surgical techniques, in medically inoperable patients, in lesions located in previously irradiated sites, or as an adjunct to surgery.

Adult↗
PubMed2003

Evidence-based review of the surgical management of vertebral column metastatic disease.

OBJECT: Significant controversy exists over the most appropriate treatment for patients with metastatic disease of the vertebral column. Treatment options include surgical intervention, radiotherapy, or a combination of the two; nevertheless, a standard of care that yields the best survival, outcome, and quality of life has not been established. The purpose of this review was to determine the foundation in the literature of views favoring surgical intervention for spinal metastatic disease. METHODS: A search of the English-language literature published between 1964 and 2003 was performed for the subject of spinal metastatic disease. Papers were selected based on the inclusion criteria described, and evidentiary information was compiled and graded using previously described methods. CONCLUSIONS: Although there is insufficient evidence to support a standard for surgical treatment in patients with metastatic spinal disease, the authors present guidelines and recommendations based on the evidence provided by the current literature.

Combined Modality Therapy↗
PubMed2003

CyberKnife frameless single-fraction stereotactic radiosurgery for tumors of the sacrum.

OBJECT: The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. The experience with radiosurgery for the treatment of spinal and sacral lesions is more limited. Sacral lesions should be amenable to radiosurgical treatment similar to that used for their intracranial counterparts. The authors evaluated a single- fraction radiosurgical technique performed using the CyberKnife Real-Time Image-Guided Radiosurgery System for the treatment of the sacral lesion. METHODS: The CyberKnife is a frameless radiosurgery system based on the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the intended target without the need for frame-based fixation. All sacral lesions were located and tracked for radiation delivery relative to fiducial bone markers placed percutaneously. Eighteen patients were treated with single-fraction radiosurgery. Tumor histology included one benign and 17 malignant tumors. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographically documented tumor volume with no margin. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 15 Gy). Tumor volume ranged from 23.6 to 187.4 ml (mean 90 ml). The volume of the cauda equina receiving greater than 8 Gy ranged from 0 to 1 ml (mean 0.1 ml). All patients underwent the procedure in an outpatient setting. No acute radiation toxicity or new neurological deficits occurred during the mean follow-up period of 6 months. Pain improved in all 13 patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging. CONCLUSIONS: Stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of both benign and malignant sacral lesions. The major potential benefits of radiosurgical ablation of sacral lesions are relatively short treatment time in an outpatient setting and minimal or no side effects. This new technique offers a new and important therapeutic modality for the primary treatment of a variety of sacral tumors or for lesions not amenable to open surgical techniques.

Adult↗
PubMed2003

CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine.

OBJECT: The role of stereotactic radiosurgery in the treatment of benign intracranial lesions is well established. Its role in the treatment of benign spinal lesions is more limited. Benign spinal lesions should be amenable to radiosurgical treatment similar to their intracranial counterparts. In this study the authors evaluated the effectiveness of the CyberKnife for benign spinal lesions involving a single-fraction radiosurgical technique. METHODS: The CyberKnife is a frameless radiosurgery system in which an orthogonal pair of x-ray cameras is coupled to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, whereby the therapy beam is guided to the intended target without the use of frame-based fixation. Cervical spine lesions were located and tracked relative to skull osseous landmarks; lower spinal lesions were tracked relative to percutaneously placed fiducial bone markers. Fifteen patients underwent single-fraction radiosurgery (12 cervical, one thoracic, and two lumbar). Histological types included neurofibroma (five cases), paraganglioma (three cases), schwannoma (two cases), meningioma (two cases), spinal chordoma (two cases), and hemangioma (one case). Radiation dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographic tumor volume with no margin. The tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 16 Gy). Tumor volume ranged from 0.3 to 29.3 ml (mean 6.4 ml). Spinal canal volume receiving more than 8 Gy ranged from 0.0 to 0.9 ml (mean 0.2 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Pain improved in all patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging (mean 12 months). CONCLUSIONS: Spinal stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of benign spinal lesions. Its major potential benefits are the relatively short treatment time in an outpatient setting and the minimal risk of side effects. This new technique offers an alternative therapeutic modality for the treatment of a variety of benign spinal neoplasms in cases in which surgery cannot be performed, in cases with previously irradiated sites, and in cases involving lesions not amenable to open surgical techniques or as an adjunct to surgery.

Adult↗
PubMed2003

Evaluation of CyberKnife frameless real-time image-guided stereotactic radiosurgery for spinal lesions.

BACKGROUND: This study evaluated the CyberKnife frameless image-guided radiosurgery system for the treatment of spinal lesions. METHODS: This system utilizes the coupling of an orthogonal pair of X-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the therapy beam to the intended target without the use of frame-based fixation. Cervical spine lesions are located and tracked relative to skull bony landmarks; lower spinal lesions are tracked relative to fiducial markers. 125 spinal lesions in 115 consecutive patients were treated with a single-fraction radiosurgery technique. RESULTS: Tumor volume ranged from 0.3 to 232 ml (mean 27.8 ml). Tumor radiation dose was maintained at 12-20 Gy to the 80% isodose line (mean 14 Gy); the spinal cord or canal volume receiving greater than 8 Gy ranged from 0.0 to 1.7 ml (mean 0.2 ml). No acute radiation toxicity or new neurological deficits occurred during the follow-up period (3-24 months). CONCLUSIONS: The CyberKnife system was found to be feasible, safe and effective. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and good response.

Adult↗
PubMed2003

Low-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome.

OBJECT: The authors of clinical studies have demonstrated a significant association between the presence of extensive post-lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed-back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. METHODS: Ten patients with symptomatic post-discectomy peridural fibrosis were randomized. Half of the patients underwent 700-cGy external-beam irradiation to the operative site 24 hours prior to reexploration and decompressive treatment of their symptomatic nerve root(s) (treatment group) and the other half underwent reexploration and decompressive treatment without preoperative irradiation (control group). All patients underwent simulated irradiation so neither patient nor surgeon was aware of the patient's group. In all patients the antiadhesion product ADCON-L was placed over the affected nerve root at the time of surgery. Clinical outcome was assessed using the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire at baseline, 6 weeks, 3 months, and 1 year follow up. Five men and five women (mean age 42 years) underwent randomization and surgery. Three patients underwent reexploration at L4-5, four at L5-S1, and three at both levels. No complication was associated with irradiation, and no new neurological deficits occurred. At 1-year follow-up examination, three irradiation-treated patients were pain free and two experienced improvement. In the control group, three patients experienced improved pain relief and two were unchanged. There was a trend toward better outcome at 1 year in the radiotherapy-treated group (p = 0.056). CONCLUSIONS: Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.

Adult↗
PubMed2002

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions.

OBJECT: The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. METHODS: This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. CONCLUSIONS: Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

Feasibility Studies↗
PubMed2002

Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty.

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.

Diskectomy, Percutaneous↗
PubMed2002

Use of polylactide resorbable film as an adhesion barrier.

OBJECT: The present investigation evaluates two thicknesses of a resorbable polylactic acid (PLA) barrier film as an adhesion barrier to posterior spinal scar formation. METHODS: A readily contourable, thin film was placed directly over the dura. The thick film was placed above the lamina defect to act as a physical barrier inhibiting the prolapse of soft tissue into the epidural space. Through a combination of gross dissection with and without scar scores, quantitative analysis of collagen adjacent to the scar site, and histological evaluation, the resorbable adhesion barrier membranes were found to be effective treatment for reduction of posterior adhesions. CONCLUSIONS: The gross dissection demonstrated that both thicknesses of resorbable PLA barrier films created a controlled dissection plane, facilitated access to the epidural space, and provided a reduction in the tissue adherent to the dura.

Absorbable Implants↗
PubMed2002

Use of polylactide resorbable film as an adhesion barrier.

The present investigation evaluates two thicknesses of a resorbable polylactide barrier film as an adhesion barrier to posterior spine scar formation. A readily contourable, thin film was placed directly over the dura. The thick film was placed above the lamina defect to act as a physical barrier inhibiting the prolapse of soft tissue into the epidural space. Through a combination of gross dissection with and without scar scores, quantitative analysis of collagen adjacent to the scar site, and histologic evaluation, the resorbable adhesion barrier membranes were found to be effective treatment for reduction of posterior adhesions. The gross dissection demonstrated that both thicknesses of resorbable polymer barrier films created a controlled dissection plane, facilitated access to the epidural space, and provided a reduction in the tissue adhered to the dura.

Absorbable Implants↗
PubMed2002

A prospective outcomes study of patients undergoing intradiscal electrothermy (IDET) for chronic low back pain.

This prospective, non-randomized clinical trial was designed to determine the clinical outcome of patients who underwent Intradiscal Electrotherapy (IDET) for the treatment of chronic discogenic low back pain. Twenty-seven consecutive patients undergoing IDET were prospectively evaluated. All patients, as determined by provocative discography and/or MRI, had discogenic disease with chronic low back pain and were non-responsive to conservative treatment for at least 6 months. The mean pre-operative duration of symptoms was 38 months. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section Lumbar Disc Herniation Study Questionnaire, which includes the Oswestry Low Back Pain Disability Questionnaire and the Short Form (SF) -36 Health Status Questionnaire, was used. The follow-up endpoint for all patients was one year. Seventy-five percent of patients improved based upon the Oswestry Low Back Pain Disability Questionnaire while only 48% of patients were found to improve on the SF-36 Survey. The SF-36 Bodily Pain Subscale did improve relative to other subscales in 52% of patients. There was no relationship found between outcome and duration of symptoms (p= .32), number of levels treated (p= .20), or worker's compensation (p= .38). There were no complications that resulted from the IDET treatment. IDET was found to be effective in 75% of patients in improving their chronic low back pain. This did not translate into a significant improvement in the SF-36 survey scores. The risks are negligible, and recovery time is minimal. The procedure may be useful in selected patients who would otherwise undergo an interbody fusion procedure.

Journal Article↗
PubMedDate not supplied

Implantable direct current stimulation in para-axial cervical arthrodesis.

This retrospective, case-controlled pilot study was designed to examine the efficacy and safety of an implantable direct current bone growth stimulator (IDCBGS) as an adjunct to cervical arthrodesis in patients at high risk for nonunion after undergoing cervical fusion in region from the occiput to C3. Twenty patients underwent para-axial cervical arthrodesis (involving posterior spine fusion and instrumentation using standard surgical techniques) for the correction of instability. All were at high risk for nonunion due to advanced age, rheumatoid arthritis, prior failed fusion attempts, infection, or immunosuppressive drug use. An IDCBGS was used to augment the surgical procedure. The mean follow-up period was 19 months, and 16 patients were available for follow-up. Radiographic evidence of fusion was demonstrated in 15 of 16 patients (94%). After surgery, all patients demonstrated clinical stabilization, a resolution of symptoms in combination with an improvement in neurologic status, or both. The mean elapsed time before fusion occurred was 4.6 months. No neurologic complications related to cathode or generator placement were observed. The use of the stimulator as an adjunct to instrument- or non-instrument-assisted surgical fusion of the para-axial region in these high-risk patients appeared both safe and efficacious. Further investigation is warranted to define the possible role and clinical utility of the IDCBGS in selected patients requiring cervical fusion, particularly those at high risk for nonunion.

Adolescent↗
PubMedDate not supplied

Iatrogenic vertebral artery injury during anterior cervical spine surgery.

BACKGROUND CONTEXT: Iatrogenic injury to the vertebral artery during an anterior cervical decompression is a rarely mentioned but potentially catastrophic complication. PURPOSE: This study was designed to examine the incidence and management of iatrogenic vertebral artery injury (IVAI) in a large database. STUDY DESIGN/SETTING: This was a retrospective study performed at a large teaching institution over a 7-year period (1994-2001). PATIENT SAMPLE: All anterior cervical spinal procedures performed for herniated or degenerative disc disease, or cervical spondylosis were identified, as were incidences of IVAI. Anterior cervical procedures performed for trauma, neoplasia, or infection were excluded from this study. OUTCOME MEASURES: Neurological and associated morbidity as well as mortality were recorded. METHODS: Data were accessed through an institution-wide electronic medical record search through the operative reports of 10 spine surgeons. Hospital and clinical charts of IVAI cases were subsequently reviewed. Demographic data and intraoperative strategies for repair were recorded. RESULTS: A total of 1,976 patients underwent anterior cervical spinal procedures in the review period. Six cases of IVAI were identified. In three of the six patients, arterial bleeding was controlled with hemostatic agents. Of these three, two suffered complications. The initial management of controlling arterial bleeding is by hemostatic agents; however, one must also consider repair or ligation. The remaining three patients were treated with primary repair or ligation, and no complications were noted. CONCLUSIONS: IVAI is a rare complication (0.3%) of anterior cervical procedures. The arterial bleeding can usually be controlled with topical hemostatic agents, but mortality may occur in instances where it cannot be adequately addressed in a timely fashion.

Cervical Vertebrae↗