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At least 235 records · Page 13Linked to original sources
PubMed1999

Cervical myelopathy due to dynamic compression by the laminectomy membrane: dynamic MR imaging study.

Dynamic magnetic resonance (MR) imaging is useful in assessing delayed neurologic deterioration after multilevel cervical laminectomy. The authors report a case of a 75-year-old woman who deteriorated 24 years after a C4-C7 laminectomy. When the extension MR demonstrated marked spinal cord compression attributable to a laminectomy membrane, the patient had an anterior diskectomy and fusion performed, after which she demonstrated significant neurologic improvement. In this and other cases, the dynamic MR may be a useful tool in discerning the etiology of the delayed neurologic changes occurring in postoperative patients.

Aged↗
PubMed2002

Indications for lumbar microdiskectomy.

A very high percentage of patients coming to surgery for large disk extrusions and sciatica do very well with minimally invasive diskectomy. In most patients given relatively early surgical treatment, the primary predictor of outcome is the size of the disk herniation and the remaining competency of the anulus fibrosus. With the passage of time and with prolonged disability before surgery, psychosocial factors become increasingly important in determining outcomes. Factors such as psychological distress, depression, involvement with workers' compensation claims and disability claims, drug and alcohol abuse, and level of education appear to be secondary factors, at least initially, in subjects with large extruded fragments. In subjects with smaller disk herniation or in those with chronic disability, these factors may indicate a higher risk of treatment failure.

Diagnostic Imaging↗
PubMed2003

Anterior cervical approaches for cervical radiculopathy and myelopathy.

Compression of the spinal cord and nerve roots caused by spondylotic changes or disk herniations is the most common etiology for cervical myelopathy, radiculopathy, or myeloradiculopathy. Surgical intervention in treating these conditions has been very successful. Anterior approaches to the cervical spine are being used for the treatment of cervical radiculopathy and myelopathy. The technical aspects of anterior diskectomy and corpectomy, methods of fusion, and the use of instrumentation are important treatment considerations.

Bone Transplantation↗
PubMedDate not supplied

[Obstetric analgesia for a patient with a history of 3 previous operations on the spine].

A history of spinal surgery is not currently considered a contraindication for regional obstetric analgesia. However, there are highly complex cases in which choosing the best analgesic technique presents genuine problems. We report the case of a woman in labor at full-term with 4-cm dilatation of the cervix who had undergone 3 operations for scoliosis and a herniated disk treated by T5-L4 and L4-sacral arthrodesis, laminectomy, and diskectomy. No previous anesthetic plan was in place, so we chose intravenous patient-controlled analgesia for labor and vaginal delivery and spinal anesthesia for a cesarean delivery. However, general anesthesia became necessary because it was impossible to reach the dura mater. The literature was reviewed to assess alternative forms of obstetric analgesia for patients who have undergone scoliosis surgery.

Adult↗
PubMed1994

Recurrent disk versus scar in the postoperative patient: the role of computed tomography (CT)/diskography and CT/myelography.

The purpose of this study was to compare computed tomography (CT)/myelography and CT/diskography images, in a given patient, as a method of distinguishing postoperative fibrosis from recurrent herniated disk material. The study population consisted of 20 patients who had undergone lumbar diskectomy and subsequently developed recurrent radicular pain. All patients underwent CT/myelography and CT/diskography, each procedure performed within 72 h of the other. Comparison of transaxial images from CT/myelography and CT/diskography at a given disk space level yielded the following results: in 12 patients the extradural mass seen via CT/myelography corresponded entirely to the contrast-filled disk fragment seen via CT/diskography (recurrent herniated disk); in three patients the extradural mass seen via CT/myelography was larger than the disk fragment seen via CT/diskography (recurrent herniated disk and fibrosis); and in five patients CT/diskography images appeared normal, but CT/myelography showed an extradural mass (fibrosis). Fifteen patients underwent surgical reexploration with the following results: in three of three patients, the suspicion of recurrent herniated disk and fibrosis by radiologic evaluation was confirmed by surgical reexploration; in nine of 12 patients, solely recurrent herniated disk shown by radiologic criteria was similarly confirmed. The remaining five patients presumed to have fibrosis by radiologic criteria were treated nonoperatively.

Adult↗
PubMed1994

Titanium-mesh block replacement of the intervertebral disk.

A prospective clinical trial was conducted involving patients with prolapsed lumbar intervertebral disk proven myelographically, who had anterior diskectomy and disk replacement with a titanium-mesh block implant. A pilot study was done in 1971 on six patients. In this trial, 28 patients were operated on with informed consent. Twenty-three had a minimum of five years' follow-up study. There were 14 men and boys, and nine women and girls. The average follow-up period was eight years and four months (range, five to 12 years three months). The average age at operation was 36 years four months (range, 13-66 years). Symptomatic improvement were divided into three groups. Sixteen patients were in Group 1, three in Group 2, and three in Group 3. Flexion-extension radiographs showed 14 patients with no movement between the vertebral bodies adjacent to the operated disk, five with minimal movement, and four with definite movement. At the implant-bone interface, no radiolucent zone was seen in 18 patients, and a definite radiolucent zone was seen in five. Twenty implants were intact, three implants had developed a crack, and three were deformed. There were no complications. The titanium-mesh block implant is an effective substitute for autogenous bone grafting in interbody fusion.

Adolescent↗
PubMed1996

The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk.

PURPOSE: To document the pattern of enhancement and morphologic changes on MR images that occur in the intervertebral disk and adjacent vertebral bodies after diskectomy and to correlate the presence of intervertebral disk enhancement with the preoperative and postoperative clinical findings. METHODS: Preoperatively, and at 3 months and 6 months after surgery, 94 adults who had first-time surgery for a herniated lumbar intervertebral disk that was associated with radiculopathy, expressed as leg symptoms or signs (with or without lower back pain), were asked to respond to a questionnaire regarding pain, were given serial physical examinations, and were examined with contrast-enhanced MR imaging. The measures of clinical outcome that were evaluated included the straight leg raise sign, radicular pain, and lower back pain. Type of disk herniation, intervertebral disk enhancement, disk space height, and degenerative end-plate changes were also assessed. RESULTS: Of the 94 patients evaluated, 19 (20%) had postoperative intervertebral disk enhancement that was not present on the preoperative study. The pattern of enhancement was remarkably consistent, with 18 of the cases showing linear enhancement within the intervertebral disk, manifested as two thin bands paralleling the end plates. End-plate enhancement was present in 7 (37%) of the 19 patients with disk enhancement. There were no significant associations between disk enhancement and specific clinical symptoms before or after surgery. CONCLUSION: Our group of asymptomatic postoperative patients had anular enhancement (curette site), disk enhancement, and vertebral end-plate enhancement on MR images without evidence of disk space infection. This finding points out the need to understand asymptomatic postoperative changes that are sequelae of surgery and not necessarily indicators of infection.

Adolescent↗
PubMed1997

Health care information processing: how accurate are the data?

Managed health care providers, governmental agencies, lawmakers, and the general public are now relying on informational databases to influence health care decisions. This information is also used to derive efficiency profiles for both the individual physician and the institution. However, database reporting procedures are not standardized or monitored. Further, the ICD-9-CM coding system lacks specificity. Consequently, the accuracy of the information in a typical informational database is questionable. As a result, credentialing of physicians and institutions may be based on erroneous information from inaccurate databases. The objective of our study was to document the accuracy of a local informational database. We did a retrospective review of 40 randomly selected charts with surgical procedure codes (ICD-9-CM) for decompression or diskectomy. We compared the diagnosis, procedures, comorbid events, and complications as originally recorded by the surgeon with results of our chart review. We also compared the procedure codes as originally recorded by a hospital recorder with results of our chart review. Results indicated that the information actually reported to the hospital database was lacking or inaccurate in 70% of cases. Discrepancies were not the fault of hospital coders; the coding accuracy rate was 95%. Discrepancies were largely the result of two problems. First, the primary procedure code (ie, the first code on the list recorded by the hospital medical records personnel) did not always match the actual primary procedure (ie, the most complex procedure) done by the surgeon. Second, the ICD-9-CM code was not specific enough to accurately describe the actual surgery done. We conclude that critical discrepancies were recorded into the informational database.

Adult↗
PubMed1998

The postoperative lumbar spine: evaluation of epidural scar over a 1-year period.

PURPOSE: We documented the morphological changes on enhanced MR imaging studies that occur in epidural scar over a period of 1 year after lumbar diskectomy. METHODS: The study population was culled from a randomized, multicenter clinical trial designed to evaluate the efficacy of a device inhibiting postoperative epidural fibrosis after single-level, unilateral laminectomy/diskectomy for herniated lumbar disk. Analysis was restricted to 71 control subjects who did not receive the device. All patients underwent surgery after receiving clinical and MR examinations, with follow-up MR studies at 6 and 12 months. Evaluation of all MR images was performed by one interpreter, who was blinded to treatment arm and clinical findings. The extent of epidural scar seen at the 6- and 12-month MR examinations was graded on a scale of 0 to 4 for each quadrant at each imaging section encompassing the surgical level. RESULTS: Eighty-five percent of the patients had no change in the amount of anterior epidural scar between the 6- and 12-month MR examinations; 75% of the patients showed no change in the amount of posterior epidural scar between the 6- and 12-month examinations. CONCLUSION: The majority of our patients had no change in the amount of epidural scarring visible at enhanced MR imaging over a 1-year period after lumbar laminectomy/diskectomy.

Cicatrix↗
PubMed1998

Tomographic microtherapy.

Minimally invasive techniques using endoscopes for image-guided therapy are now common in the field of surgery. Fast real-time radiologic imaging should be integrated into the procedure for increased safety in access and guidance techniques for endoscopes and instruments. The transparency of computed tomography (CT) guidance, magnetic resonance imaging, and electron beam tomography scan techniques allows precise guidance of instruments and endoscopes while permitting their diameter to be minimized. This guarantees safe and transparent access into the body, especially in high-risk areas such as the spine and brain. Combining both technologies has the potential to reduce complications and offers significant advantages in microinvasive operative procedures such as biopsies; local tumor therapy with lasers, radio frequency, or drugs; and percutaneous diskectomies or implants. CT is the golden standard for microtherapeutic procedures because of its precise tip discrimination.

Diagnostic Imaging↗
PubMed1997

Symptomatic spinal calcinosis in systemic sclerosis (scleroderma).

Two patients with diffuse cutaneous systemic sclerosis and spinal calcification, involving the lumbar spine in one and the cervical spine in the other, are described. Computed tomography-guided aspiration of the calcific masses was performed, and material aspirated from one patient was shown to be apatite, Ca5(PO4)3OH. One patient showed improvement following lumbar laminotomy, hemilaminectomy, and diskectomy.

Calcinosis↗
PubMed1993

Usefulness of MRI in the preoperative diagnosis of cervical disk herniation.

We investigated the preoperative diagnostic value of MRI, myelography, and CT myelography (CTM) in a retrospective analysis of 17 patients (15 men and two women) who were surgically treated for cervical disk herniation. Their ages ranged from 29 to 63 years, with a mean of 49 years. Anterior interbody fusion using iliac bone grafts was performed following microscopic diskectomy in all patients. MRI, myelography, and CTM were performed in 13 patients, while four patients were operated on after MRI alone. Neurological improvement was observed in all 17 patients after the surgery. MRI proved useful for determining the level of symptomatic cervical disk herniation. Surgery can be carried out on the basis of MRI findings alone when there is disk herniation at a single level which corresponds with the patient's symptoms and signs.

Adult↗
PubMed1991

Comparative study of different dorsal stabilization techniques in recent thoraco-lumbar spine fractures.

The authors initially outline the development of operative techniques to stabilize traumatic thoraco-lumbar spine fractures. Thereafter their own results in 125 patients, treated operatively between 1.1.1983 and 15.9.1988, are presented. The different techniques (Harrington-instrumentation, transpedicular plate stabilization, fixateur interne) are evaluated. In the clinical neurological examination 25% of the patients experienced an improvement by at least one point in the FRANKEL classification. Four patients suffered neurological deterioration. In the radiological follow-up the "Sintering" process, the kyphotic and scoliotic deformity of the spinal segment were measured. The fixateur interne had the best overall results (loss of reposition averaged a kyphosis of 6.8 degrees, no fracture instability). Less good results were obtained with both the Harrington stabilization (loss of reposition 9.1 degrees, fracture instability in 3 cases) and with the transpedicular plate stabilization (loss of reposition 12.4 degrees, fracture instability in 2 cases). Finally the complications are described. The optimal approach is based on the clinical development. The fusion should be as short as possible with a stable angle implant and the possibility to reposition intraoperatively should be given. Postero-lateral spongiosa application, fusion of the vertebral arch joints, diskectomy with transpedicular spongiosa application and intercorporal blocking should be considered.

Adolescent↗
PubMed1998

Percutaneous access to the anterior spinal canal through a cervical disk.

We describe a CT-guided percutaneous technique for aspiration of an anterior intraspinal fluid collection through a cervical disk. The approach is identical to that of cervical diskography or percutaneous cervical diskectomy, with intentional placement of the needle tip in the spinal canal. This procedure had no adverse effects and avoided an open operation to exclude spinal cord compression.

Adult↗
PubMed1996

Degenerative disk vascularization on MRI: correlation with clinical and histopathologic findings.

OBJECTIVE: This prospective study was designed to determine the MRI features, clinical significance, and correlation to histopathologic findings of secondary vascularized degenerative intervertebral disks. MATERIALS AND METHODS: Fifty-three patients with localized painful spine syndrome were investigated prospectively by contrast-enhanced MRI. Pain was not predominantly radiating and there was no clinical evidence of spinal infection. In all patients sagittal SE T1-weighted, fast SE T2-weighted or turbo-STIR, and T1-weighted frequency-selective fat-suppressed images were obtained. RESULTS: We identified 37 vascularized disks in 26 patients. In 18 patients the changes had occurred spontaneously, in 6, the affected disk had been operated on previously, and 2 patients had spondylolisthesis. In 15 patients, vascularization was accompanied by medullary edema adjacent to the vertebral endplates. In one of the vascularized disks, herniation was also found. In seven patients, ventral diskectomy was performed. Histopathologic findings confirmed disk vascularization in six of seven cases. CONCLUSIONS: Degenerative, band-like disk vascularization is a feature which is associated with local pain. It was demonstrated by contrast-enhanced MRI. Degenerative disk vascularization is an important differential diagnosis to bacterial spondylodiskitis. It can be a cause of pain in patients with postdiskectomy syndrome.

Diagnosis, Differential↗
PubMed2005

Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF).

Minimal access surgical techniques have been described for diskectomy and laminectomy procedures performed through tubular exposures. Tubular exposures, however, restrain visibility to a fixed diameter and require co-axial instrument manipulation. An independent blade retractor system has been developed to overcome the obstacles of working through a tube. Decompression and circumferential fusion can be accomplished through this minimal access exposure via a combination of laminectomy and transforaminal lumbar interbody fusion (TLIF) coupled with minimally invasive pedicle screw fixation. Herein, we describe a minimally-invasive technique for TLIF exposure. Illustrations, intraoperative photographs, and fluoroscopic images supplement this technique. We found that the described minimally-invasive system provides comparable exposure to the traditional-open techniques with the benefits of minimally-invasive techniques. Additionally, it does not have the added constraints of a tubular system. We were able to perform TLIFs without any additional complications. Minimal access decompression and TLIF can be performed safely and effectively using this minimally-invasive system. Besides the retractor system, no additional specialized instruments are required. An operative microscope is not required, in fact, all our cases were performed using operative loupes. The light attachment provides superb visbility without the discomfort of having to wear a headlight. Thus far we have found no added risks or complications using this system. We are currently working on long-term analysis and follow-up to further evaluate this system's efficacy.

Fluoroscopy↗
PubMed2002

A modified technique for anterior multilevel cervical fusion.

Anterior cervical fusion with interbody bone graft and anterior plating is commonly performed. Unfortunately, the plate has been reported to shield the graft from loading, thus reducing fusion rates. Interbody fusion cages have been effective in the lumbar spine and have gained acceptance in the cervical spine. Twenty-five patients underwent anterior cervical fusion with this modified technique. All patients received anterior diskectomy and corpectomy, placement of an interbody fusion cage packed with corpectomy bone, and application of an anterior cervical plate. Fusion was defined by radiographic evidence of trabecular bone bridging through the cage. No external bracing was used except soft collars as needed. Pre- and postoperative pain scales were completed and statistically analyzed using paired t tests. There were no cases of pseudoarthrosis or major neurological, vascular, or wound complications. There was one case of mild dysphagia that remained unresolved. Mean operative time was comparable to standard instrumented multilevel cervical fusion surgeries. Visual analogue pain scales were significantly improved following surgery. The advantages of using interbody cages with anterior plating include immediate stability and support, elimination of donor site pain from iliac crest bone autograft, and a decrease in pseudoarthrosis by halving the number of fusion surfaces.

Adult↗
PubMed1986

Deterioration of temporary silicone implant in the temporomandibular joint: a clinical and arthroscopic follow-up study.

Dacron-reinforced silicone material was used as a temporary disk replacement implant in twenty-seven consecutive patients who underwent diskectomy. Symptoms and the status of the implants were recorded when the implants were removed 1 to 19 months postoperatively (median, 4 months). At the time of removal of the implants, eleven patients showed mechanical dysfunction, which was associated with pain in four patients. All but one of the implants showed wearing facets, and fifteen implants were cracked or perforated. Arthroscopic examination was performed when the implant was removed in the last six patients. This revealed that the extension of the joint compartment corresponded well to the dimension of the implant. Arthroscopy also disclosed that initially even and shiny articular surfaces remained so, articular surfaces in joints with fibrous ankylosis became shiny but uneven, and arthrotic articular surfaces showed no changes. It was concluded that disk-replacement implants can prevent postoperative ingrowth of fibrous tissue and development of intra-articular adhesions and that the implant has the capacity to protect the articular surfaces as long as the material is intact. Since more than half of the implants were cracked or perforated, an implant material with mechanical properties superior to those of Dacron-reinforced silicone would be preferable.

Adult↗