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PubMed1982

Subjective postoperative results in cervical spondylotic myelopathy.

A retrospective study of operative results after a minimum follow-up period of five years was carried out in a series of 34 patients operated upon for cervical spondylotic myelopathy (CSM). In all the cases, myelography showed involvement of two or more intervertebral spaces. Constitutional spinal cord narrowing was not present, and only one operation was performed in each patient. Of the 34 patients, 16 also had symptoms of cervical spondylotic radiculopathy (CSR). Seventy-four percent of the patients thought that operation resulted in overall improvement of the preoperative clinical picture. This subjective improvement was similar whether the operative procedure consisted of anterior intersomatic fusion or of laminectomy. Amelioration of CSM symptoms occurred in only 8 of the 20 patients subjected to anterior fusion (40%), in contrast to 10 of the 14 patients subjected to laminectomy (71%). In the 16 patients with CSR symptoms associated with CSM, amelioration of CSR symptoms occurred in 6 of the 11 patients subjected to anterior fusion (55%), and in 4 of the 5 patients subjected to laminectomy 80%). It is suggested that laminectomy offers the best results for CSM, associated or not with CSR, when two or more intervertebral spaces are affected.

Adult↗
PubMed1999

Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: an experimental study.

One of the most common complications of lumbar spine surgery is peridural fibrosis, a fibroblastic invasion of the nerve roots and the peridural sac exposed at operation. Peridural fibrosis may produce symptoms similar to those the patient experienced preoperatively and, if another spinal operation is necessary, may increase the risk of injury at reexposure. In a controlled study in dogs, we assessed the use of expanded polytetrafluoroethylene (ePTFE) as a barrier to postoperative invasion of fibrous tissue into the laminectomy defect. In 14 dogs, a two-level laminectomy was done, at L4-L5 and L6-L7. In 12 dogs, an ePTFE membrane was placed directly over the dorsal surface of the laminectomy defect at L4-L5 and within the defect (over the surface of the dura) at L6-L7. No material was implanted in two dogs (controls). Tissue for histologic studies was obtained from the controls and from ten dogs with the membrane 12 weeks postoperatively. Two dogs with the membrane underwent reoperation. The study found that there was no peridural fibrosis in seven of the ten specimens in which the ePTFE membrane had been placed directly on the dorsal surface of the laminectomy defect, some peridural fibrosis in all specimens in which the membrane had been placed within the defect, and extensive fibrosis in controls. The ePTFE membrane created an excellent plane of dissection for reoperation. No foreign-body reactions to the membrane or membrane-related infections occurred. We conclude that the ePTFE spinal membrane, when properly implanted, is an effective barrier to postsurgical fibrous invasion of the vertebral canal. Clinical studies of use of this material in spinal surgery are warranted.

Animals↗
PubMed2005

Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies.

BACKGROUND: Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment. The standard approach to decompress SEA is laminectomy. No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage. METHOD: A retrospective evaluation of the medical and radiological data was undertaken in 27 consecutive patients with SEA operated on during a period of 10 years by a dorsal approach. Factors influencing outcome were evaluated with special regard to different surgical strategies concerning the invasiveness of the operative approach, the use of intra-operative ultrasound and the use of different drainage systems. FINDINGS: Outcome was mainly determined by the pre-operative neurological condition and the localization of the abscess. Recurrence rate was dependent on the longitudinal extent of the mass and the intra-operative finding of granulation tissue, but not on the administration of a postoperative suction-irrigation drainage. An interlaminar approach was equally matched to a decompression by laminectomy in lumbar SEA concerning the incidence of residual/recurrent abscess formation. In concomitant spondylodiscitis, laminectomy bore the risk of the formation of a postoperative kyphotic deformity. The use of intra-operative ultrasound allowed the visualization of hidden inflammatory masses and, thus, reduced the rate of residual abscess formation. CONCLUSION: An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.

Adolescent↗
PubMed1982

The effect of acute spinal cord compression injury on thyroid function in the rat.

The effect of acute spinal cord injury on thyroid function was studied in rats subjected to severe spinal cord compression at T1. Serum thyroxine (T4), effective thyroxine index (ETI), and thyroid stimulating hormone (TSH) were measured at 1 and 100 minutes at one, three, and seven days after laminectomy and spinal cord injury. Control animals were subjected to laminectomy only. T4 was decreased at 1 minute after laminectomy with or without spinal cord injury, though the animals with cord injury had a much more profound reduction. The effects on TSH at 1 minute were dramatically different: laminectomy alone caused an elevation of TSH, while spinal cord injury produced a marked decline. At the later time intervals both groups showed gradual normalization of T4 and TSH levels, and at seven days there were no significant differences between the groups. Thus, acute spinal cord compression injury produced a major alteration in thyroid function during the acute phase.

Acute Disease↗
PubMedDate not supplied

Evaluation of hyaluronic acid sheet for the prevention of postlaminectomy adhesions.

BACKGROUND CONTEXT: Various materials have been tested for their ability to maintain a barrier between muscles and epidural space in order to physically or chemically inhibit scar ingrowths. Hyaluronic acid (HA) solution and gel have been reported to be effective in preventing adhesions postlaminectomy; however, neither has been used clinically after spinal surgery. PURPOSE: To determine the efficacy of HA sheet for the prevention of postlaminectomy adhesions compared with that of HA gel or another sheet. STUDY DESIGN/SETTING: An animal model of lumbar laminectomy in rabbits was used to study postoperative scar tissue formation around the spinal cord. The histologic effects of HA sheet were compared with those of Gelfoam (GF) and further evaluated by an inflammation model using rhTNF-alpha. PATIENT SAMPLE: Rabbit. OUTCOME MEASURES: Histologic examination. METHODS: Five rabbits were killed at 2, 4, 8, and 24 weeks after laminectomy, respectively. Another 18 rabbits were examined in an environment of active inflammation experimentally induced by rhTNF-alpha to compare the effects of HA sheet with those of GF or HA gel. Histologic examination was performed to quantitatively assess invasive scar formation or inflammation postlaminectomy, and then, the histologic effects of HA sheet were compared with those of GF or HA gel. RESULTS: In the HA group, significantly, the area of subarachnoid space was larger, distance from the surface of dura to scar tissues was greater, the number of inflammatory cells in the scar tissues at the site of laminectomy was less, and enlargement of dura was suppressed. Using an inflammation model, we also demonstrated the efficacy of HA sheet treatment. CONCLUSIONS: In an experimental laminectomy model, HA sheet formed a solid interpositional membrane barrier and exhibited anti-inflammatory activity. Further investigations will be needed for HA sheet to be used clinically.

Animals↗
PubMed1998

Review: complications of surgery for thoracic disc disease.

BACKGROUND: Thoracic discectomy has evolved over the last 60 years from resection through standard laminectomy, to posterolateral procedures to open thoracotomy and finally thoracoscopy. Comparison of relative morbidity and mortality between these approaches is now possible. METHODS: Peer-reviewed publications reporting clinical data relating to thoracic discectomy, and which provided sufficient information to enable adequate assessment of mortality and morbidity were reviewed. These articles were determined via review of the results of MedLine searches and articles gathered through compilation of references from those articles. RESULTS: Articles reviewed spanned a period of over 60 years. Surgical procedures used for thoracic discectomy included laminectomy, pediculectomy, costotransversectomy, lateral extracavitary, transverse arthropediculectomy, anterolateral thoracotomy, and thoracoscopy. Complications included death, paralysis, paresis, loss of bowel and/or bladder control, pulmonary embolism, pneumonia, atelectasis, compression fracture, infection, pleural tear, bowel obstruction, and anesthesia dolorosa. Mortality dropped to nearly zero after development of anterior and posterolateral approaches. Morbidity seems relatively similar between most procedures other than laminectomy. Not enough procedures have been reported using thoracoscopy to adequately assess its morbidity. CONCLUSION: Comparison of relative rates of morbidity and mortality between surgical approaches to thoracic discectomy suggest that laminectomy does not provide adequate access for the safe removal of these lesions. Choice of approach among the alternatives should be based on the evacuation of the herniated fragment and experience of the surgeon. Thoracoscopy, although promising, has not had sufficient time for evaluation of morbidity to make definite statements regarding its safety.

Diskectomy↗
PubMed2002

Treatment decisions about lumbar herniated disk in a shared decision-making program.

BACKGROUND: An explicit process of collaborative (shared) decision making involving the patient and physician has been recommended for discretionary surgical procedures in which small-area analysis demonstrates high variation not attributable to differences in the patient population in the area. One such example is laminectomy for lumbar herniated disk (HD). An observational study was undertaken to evaluate the impact of an HD videodisk program on patient satisfaction, decision making, and treatment preferences. METHODS: Enrollment occurred in the outpatient offices of surgeons treating Kaiser Permanente (Colorado Region) patients with HD who had indications for surgery. Enrollment took place from May 1993 to December 1995, and follow-up surveys of patients were completed by January 1997. RESULTS: A 6.0% decrease in the undecided group and a 1.3% decrease in the group preferring nonsurgical treatment drove a shift of patients toward laminectomy, from 26.7% to 35.8% (Wilcoxon signed rank test = 349.5, p = .017). Postviewing preference (74.0%) was a better aggregate predictor of the ultimate treatment than previewing preference (70.0%) for laminectomy. DISCUSSION: Viewing the videodisk increased the preference for laminectomy. However, limitations in the data prevented us from determining whether this change in preference was actually reflected in patients' ultimate decisions. The fact that the strongest predictor of choosing surgery was the patient's valuation of his or her condition supports shared decision making, with its emphasis on patient's values. Participation in other videodisk programs has been low; perhaps physicians should ask patients to view these videodisks before their visits.

Adult↗
PubMed1997

Delayed cervical epidural hemorrhage associated with silastic dural implant: case report.

OBJECTIVE AND IMPORTANCE: This is the first report of delayed cervical epidural hemorrhage caused by an onlay silastic graft placed over the dura after laminectomy. There are several reports of intracranial hemorrhage associated with silastic implants in the literature. CLINICAL PRESENTATION: A 49-year-old woman suddenly developed severe neck pain and quadriplegia during sexual intercourse. A C5-C7 laminectomy had been performed 17 years earlier for cervical stenosis. INTERVENTION: Magnetic resonance imaging showed an epidural mass compressing the cord at the level of the previous laminectomy. Laminectomy was performed within 5 hours of symptom onset. Postoperatively, the patient regained leg strength. After 2 months of physical therapy, she had minimal residual leg rigidity and returned to work. TECHNIQUE: At surgery, the cervical cord was compressed by a solid fibrous scar surrounding a silastic onlay graft and the dura. An epidural hematoma was beneath the silastic implant. The dense scar tissue, hematoma, and silastic implant were removed. CONCLUSION: Bleeding associated with silastic sheets starts with movement of this nonadherent implant. The movement disrupts the underlying fine vessels on the surface of an encasing connective tissue membrane. Overgrowth of this membrane can cause mass effect and simulate a tumor, even without associated bleeding, within weeks. Delayed hemorrhage is more common. We recommend removal of these implants electively, especially if a thick membrane surrounding the dura is detected with postcontrast-enhanced magnetic resonance imaging.

Dura Mater↗
PubMed2000

Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia.

OBJECTIVE: The optimal surgical treatment of Chiari malformation is unclear, especially in patients with hydromyelia. Various surgical approaches have included suboccipital craniectomy, syringostomy, obex plugging, syringosubarachnoid shunting, and fourth ventriculosubarachnoid shunting. The purpose of this study is to differentiate extradural and intradural approaches in the treatment of Chiari I malformation. METHODS: We reviewed the medical records and magnetic resonance imaging (MRI) scans of 34 surgical corrections' of Chiari malformation performed at our institution from 1988 to 1998. The age and sex of the patient, the presence of hydromyelia, the type of surgery (duraplasty or nonduraplasty), and the clinical outcome were determined. RESULTS: Eleven patients underwent posterior fossa decompression (PFD) and C1 laminectomy without duraplasty. Eight (73%) of these patients had an improvement in symptoms. Seven of the 11 patients had hydromyelia. Of the six patients who underwent follow-up MRI, three (50%) had a decrease in the size of the hydromyelia, and all three had clinical improvement. We also noted a morphometric increase in posterior fossa volume on postoperative MRI scans in these three patients, which was not observed in those without improvement. Two of the three patients whose hydromyelia did not decrease on follow-up MRI scans worsened clinically, and one underwent a reoperation with duraplasty. Twenty-three patients underwent combined PFD, C1 laminectomy, and duraplasty. Twenty (87%) of these patients had improvement. Twelve of the patients who underwent duraplasty had hydromyelia; nine underwent follow-up MRI. All nine of these patients (100%) had a decrease in the cavity size, including eight with clinical improvement. There were 10 minor complications (seroma, 4; superficial infection, 3; cerebrospinal fluid leak, 2; aseptic meningitis and occipital nerve pain, 1) when the dura was opened, compared with one superficial wound infection that resolved in patients who underwent PFD only. CONCLUSION: PFD, C1 laminectomy, and duraplasty for the treatment of Chiari I malformation may lead to a more reliable reduction in the volume of concomitant hydromyelia, compared with PFD and C1 laminectomy alone. However, there seems to be a subset of patients whose symptoms will resolve and whose hydromyelic cavity will decrease with the removal of bone only. These patients seem to undergo a volumetric increase in the posterior fossa. Further studies are needed to better characterize these patients, to determine which patients with Chiari I malformation are better served with bony decompression only, and which will require duraplasty to resolve their hydromyelia.

Adolescent↗
PubMedDate not supplied

Surgery for myelopathy in cervical spondylosis: safety measures and preoperative factors related to outcome.

In 85 patients with myelopathy and cervical spondylosis, Queckenstedt's test was used as a guide in deciding upon laminectomy under local anesthesia or anterior surgery under general anesthesia. Laminectomy was carried out in patients with marked block phenomena. The operations were laminectomy (51), anterior surgery (24), and laminectomy plus anterior surgery (10). None of the patients was made worse as a result of the surgical procedure. Improvement in the legs occurred in 73 patients. Block phenomena and arm symptoms were preoperative factors related to improvement in the legs after surgery. Improvement in the arms occurred in 63 of 73 patients who had such symptoms.

Adult↗
PubMed1991

Viscous carboxymethylcellulose in the prevention of epidural scar formation.

Six chemical agents were evaluated for their efficacy in preventing epidural scar formation following laminectomy in rabbits. One agent was carboxymethylcellulose and the other five agents represented various compositions of modified carboxymethylcellulose. Four weeks after laminectomy, spines were harvested and decalcified, and transverse sections were prepared for histologic analysis. Subjective evaluation suggested that two agents appeared to inhibit epidural scar formation compared with the untreated controls. Objective evaluation was performed by quantitating scar tissue area at the laminectomy site with a digitizing tablet. In agreement with the subjective evaluation, two agents were found to have significantly reduced epidural scar tissue area compared with the control (control = 0.418 +/- 0.16 SE mm2vs. Agent 2 = 0.067 +/- 0.02 [P less than 0.05] and Agent 5 = 0.089 +/- 0.02 [P less than 0.05]). Of the remaining four agents, one of which was the unmodified carboxymethylcellulose, none showed significant reduction in scar tissue formation. These findings indicate that viscous preparations of modified carboxymethylcellulose can act as a barrier against epidural scar formation following laminectomy.

Animals↗
PubMed1993

Attempted experimental modification of the postlaminectomy membrane by local instillation of recombinant tissue-plasminogen activator gel.

A prospective, randomized, blinded trial involving 25 adult mongrel dogs was performed to evaluate whether placement of a fat graft or local instillation of recombinant tissue-plasminogen activator gel (rt-PA) could modify the development of a postlaminectomy membrane. One component of the study involved the performance of a lumbar laminectomy and placement of gel rt-PA, free fat, or no tissue placement over the exposed dura mater. Three months later the animals were killed and sections of spine were removed en bloc, decalcified, and examined histologically. No significant differences were found in the degree of cellular fibrosis or heavy collagen production. A similar laminectomy at another lumbar level was also followed by gel rt-PA, free fat, or no tissue placement. Three months after surgery, surgery was performed again at this level immediately before death. There were no differences in the adhesiveness of the laminectomy membrane to dura mater or roots. It was concluded that the local instillation of gel rt-PA after laminectomy did not inhibit scar formation or scar adherence to the dura mater.

Adipose Tissue↗
PubMed1996

Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches.

STUDY DESIGN: This study compared the effectiveness of two transpedicular screw placement techniques: blind screw placement versus screw placement after direct determination of the superior, medial, and inferior borders of the pedicle through the opening of a "window" by the partial laminectomy and tapping technique. OBJECTIVES: To determine if the incidence and severity of pedicle violations resulting from transpedicular screw placement could be reduced by direct determination of the superior, medial, and inferior borders of the pedicle through the opening of a "window" by partial laminectomy. SUMMARY OF BACKGROUND DATA: Several studies regarding transpedicular screw fixation for unstable cervical spine injuries have been reported, but none has addressed the effectiveness in lowering the incidence of pedicle violation by opening a "window" by partial laminectomy for direct determination of the superior, medial, and inferior borders of the pedicle and using the tapping technique before and in planning for screw placement. METHODS: Eight adult cadaveric cervical spines (40 vertebrae from C3 to C7) were used for this study. Two groups were formed according to screw placement techniques. The first group was composed of 38 blinded transpedicular screw placements. The second group was composed of 40 screw placements using the partial laminectomy and tapping technique. After transpedicular screw placement, all specimens were evaluated radiographically and visually for violation of the pedicle. RESULTS: A decrease in the incidence and severity of pedicle violation was seen in the second group with opening of the lamina and tapping technique compared with the blind screw placement group. However, the percentage of screws found to violate the pedicle with the opening of the lamina and tapping technique still was relatively high. CONCLUSIONS: Transpedicular screw placement in the cervical spine is difficult, and a high percentage of violations of the pedicle wall occur. This technique should not be used routinely.

Anatomy, Cross-Sectional↗
PubMed1999

Progesterone is neuroprotective after acute experimental spinal cord trauma in rats.

STUDY DESIGN: A standardized rat contusion model was used to test the hypothesis that progesterone significantly improves neurologic recovery after a spinal cord injury that results in incomplete paraplegia. OBJECTIVES: To compare the effect of progesterone versus a variety of control agents to determine its effectiveness in promoting neurologic recovery after an incomplete rat spinal cord injury. SUMMARY OF BACKGROUND DATA: Progesterone is a neurosteroid, possessing a variety of functions in the central nervous system. Exogenous progesterone has been shown to improve neurologic function after focal cerebral ischemia and facilitates cognitive recovery after cortical contusion in rats. METHODS: A standardized rat contusion model of spinal cord injury using the New York University impactor that resulted in rats with incomplete paraplegia was used. Forty mature male Sprague-Dawley rats were randomly assigned to four groups: laminectomy with sham contusion, laminectomy with contusion without pharmacologic treatment, laminectomy with contusion treated with dimethylsulfoxide and dissolved progesterone, and laminectomy with contusion treated with dimethylsulfoxide. Functional status was assessed weekly using the Basso-Beattie-Bresnehan (BBB) locomotor rating scale for 6 weeks, after which the animals were killed for histologic studies. RESULTS: Rats treated with progesterone had better outcomes (P = 0.0017; P = 0.0172) with a BBB score of 15.5, compared with 10.0 in the dimethylsulfoxide control group and 12.0 in the spinal cord contusion without pharmacologic intervention group. This was corroborated in histologic analysis by relative sparing of white matter tissue at the epicenter of the injury in the progesterone-treated group (P < 0.05). CONCLUSIONS: Rats treated with progesterone had a better clinical and histologic outcome compared with the various control groups. These results indicate potential therapeutic properties of progesterone in the management of acute spinal cord injury.

Acute Disease↗
PubMed2002

Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries.

STUDY DESIGN: A retrospective study of blood transfusion practices after posterior lumbar spine surgery was performed. OBJECTIVES: To determine the overall use rate of autologous blood donations for different spine surgeries, and to identify the risk of requiring additional allogeneic blood transfusions. SUMMARY OF BACKGROUND DATA: In an attempt to avoid allogeneic blood transfusions and its associated risks, patients frequently are asked to donate autologous blood before many elective spine surgeries. There is a lack of published data on the use rate for these autologous blood donations, and on their ability to prevent allogeneic blood exposure. METHODS: A retrospective review of hospital charts and blood bank records was conducted on 191 consecutive patients who had undergone three categories of lumbar spine surgery: laminectomy alone, laminectomy with a noninstrumented posterolateral fusion, and laminectomy with an instrumented posterolateral fusion. RESULTS: Nearly 80% of the autologous blood donated by patients who underwent simple laminectomies was wasted. However, the vast majority (70-90%) of patients who underwent fusion used their autologous blood. In the patients who underwent fusion, autologous blood donations decreased the risk of allogenic blood transfusions by 75% in noninstrumented fusions and 50% in instrumented fusions, as compared with the patients who elected not to donate blood before the fusion (P < 0.05). A substantial number of patients who underwent instrumented fusions (nearly 40%) required additional allogeneic blood transfusions despite predonation of blood. CONCLUSIONS: Autologous blood donations are indeed advantageous in decreasing allogeneic blood usage of patients undergoing fusion, but additional methods of blood conservation (intraoperative salvage and preoperative erythropoietin) seem necessary to diminish the allogeneic blood requirements further, especially in those patients undergoing instrumented lumbar fusion.

Aged↗
PubMed2004

Cervical ventral epidural pressure response to graded spinal canal compromise and spinal motion.

STUDY DESIGN: A laboratory investigation using a feline model of graded ventral spinal canal compromise was performed. OBJECTIVE: To quantify the effects of graded ventral spinal canal compromise, both in the static condition and in combination with passive spinal motion, on cervical ventral epidural pressure (CVEP). The CVEP effects of laminectomy are also investigated. SUMMARY OF BACKGROUND DATA: Spinal canal compromise, both in the static condition and in combination with passive spinal motion, has been implicated as a cause of spinal cord dysfunction. METHODS: Seventeen cats underwent anterior corpectomy of C3 and placement of a flexible ventral graded compression device incorporating a pressure transducer. Ten animals also underwent laminectomy of C3. The implant was advanced stepwise into the spinal canal. CVEP was measured, at each degree of canal compromise, in the flexed, extended, and neutral positions, as well as during neck movement. RESULTS: CVEP rose as a function of spinal canal compromise. In animals without laminectomy, mean CVEP was higher in the extended position and lower in the flexed position than in the neutral position. Mean CVEP during continuous passive neck movement was found to be higher than mean CVEP in the neutral position. Laminectomy was found to lower CVEP during all conditions examined, although substantial rises in CVEP were still observed in the presence of a residual ventral mass. All reported differences were statistically significant (P < 0.05). CONCLUSIONS: CVEP is elevated by both spinal canal compromise and spinal motion.

Animals↗
PubMed2005

The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion.

STUDY DESIGN: A prospective study. OBJECTIVES: To compare the efficacy of calcium sulfate pellets plus laminectomy bone chips with a fresh autologous iliac bone graft for short-segment lumbar fusion. SUMMARY OF BACKGROUND DATA: Bone graft substitute material can be used to expand an existing quantity of available laminectomy bone chips. METHODS: Seventy-four patients underwent surgery for instrumented one- or two-segment fusion with decompression. Autologous iliac crest bone graft was placed in one posterolateral gutter, while on the other side, an equal quantity of autogenous laminectomy bone supplemented with calcium sulfate was placed. Radiographic assessment included radiographs alone; this was performed every 3 months (3 months to 12 months), then annually. The status of fusion and the relative size of the fusion bone mass on either side of the vertebra were compared. RESULTS: Using iliac crest bone graft (control side) versus autograft laminectomy bone with calcium sulfate (test side), there was no significant difference between the fusion rate and sizes of the fusion bone mass (P > 0.05). Follow-up periods ranged from 30 months to 34 months, averaging 32.5 months. For the 39 patients who received single-segment fusion, 34 patients (87.2%) exhibited bone fusion on the test side, and 35 patients (89.7%) had evidence of fusion on the control side. For the 35 patients who received two-segment fusion, 29 patients (82.9%) exhibited bone fusion on the test side and 30 patients (85.7%) demonstrated complete fusion on the control side. CONCLUSIONS: The fusion rate and fusion size between the two groups are similar. Calcium sulfate pellets may play a role as a bone graft extender in short-segment spinal fusion.

Adult↗
PubMed1987

The role of vertebral body collapse in the management of malignant spinal cord compression.

The management of malignant spinal cord compression has been reviewed recently and attention drawn to the adverse effects of laminectomy. Data from that review suggested that the presence of vertebral body collapse could have an important negative effect on the outcome of laminectomy. However, there was only scant evidence available in the literature to support that conclusion. Eighty consecutive patients with thoracic spinal cord compression due to a single metastasis treated by laminectomy are reported here. It is seen that the presence of vertebral collapse signified: a much reduced chance of regaining the ability to walk; a much greater possibility of further neurological deterioration; and a major increase in the incidence of post-operative spinal instability. The role of laminectomy in the management of such patients needs to be further questioned and alternative therapeutic measures such as radiotherapy, posterior spinal instrumentation or anterior surgery should be strongly considered in the presence of vertebral body collapse.

Adolescent↗