Use of the operating microscope in anterior cervical discectomy without fusion

1975 ◽  
Vol 43 (4) ◽  
pp. 452-456 ◽  
Author(s):  
Hal L. Hankinson ◽  
Charles B. Wilson
Keyword(s):  
Bone Grafting ◽  
Anterior Cervical Discectomy ◽  
Long Term Results ◽  
Multiple Level ◽  
Operating Microscope ◽  
Content Type ◽  
Cervical Discectomy ◽  
Difficult Cases ◽  
Fine Print

✓ The authors report their experience using the operating microscope in 52 anterior cervical discectomies without fusion. They found long-term results highly satisfactory, even in difficult cases with multiple-level disease, and complications from bone grafting were obviated. They highly recommend this approach for radicular, nonradicular, or myelopathic symptoms.

Anterior cervical discectomy without bone graft

1977 ◽  
Vol 47 (4) ◽  
pp. 551-555 ◽  
Author(s):  
Donald H. Wilson ◽  
Dwight D. Campbell
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Content Type ◽  
Cervical Discectomy ◽  
Without Bone Graft ◽  
Fine Print

✓ Anterior cervical discectomy without bone grafting may become the procedure of choice for acute cervical disc protrusions. This operation was performed on 71 patients, all of whom were followed from 1 to 6 years. Complications were minor in nature. The results were excellent and sustained.

Posterior plates in the management of cervical instability: long-term results in 44 patients

1994 ◽  
Vol 81 (3) ◽  
pp. 341-349 ◽  
Author(s):  
Michael G. Fehlings ◽  
Paul R. Cooper ◽  
Thomas J. Errico
Keyword(s):  
Bone Grafting ◽  
Long Term Results ◽  
Anterior Fusion ◽  
Content Type ◽  
Pull Out ◽  
Long Term Follow Up ◽  
Cervical Plating ◽  
Fine Print

✓ Although posterior plates are increasingly used to manage cervical spinal instability, long-term follow-up evaluation of patients with a critical analysis of efficacy and complications has not been reported. The authors have retrospectively analyzed the outcome in 44 consecutive patients (37 males and seven females, age range 16 to 80 years) treated with posterior cervical plates. The indications for instrumentation were instability due to trauma in 42 cases, tumor in one, and infection in one. In four patients the follow-up period was limited to 3, 5, 11, and 16 months. Two patients died of chronic medical problems 4 and 9 months after treatment. The remaining 38 patients were followed from 2 to 6 years (mean 46 months). One motion segment was stabilized in 23 patients using two-hole plates; two motion segments were stabilized in the other 21 patients using three-hole plates. In the majority of patients (37 cases), supplemental bone grafting was not used. Patients were immobilized postoperatively in a Philadelphia collar. Solid arthrodesis was achieved in 39 (93%) of 42 patients. Three patients required revision of the cervical plating: in one patient with a C-5 burst fracture, two-hole plates were applied at C5–6 and progressive kyphosis mandated anterior fusion; the second patient required posterior wiring due to screw pull-out resulting from a technical error in screw insertion; the third patient, who refused to wear an orthosis postoperatively, also developed screw pull-out. In two patients who went on to spinal fusion, there was an increase in sagittal kyphosis (6° and 8°) without clinical sequelae. Screw loosening was noted in five patients, involving eight (3.8%) of the 210 lateral mass screws; this complication resulted in instrumentation failure or increased kyphosis in three cases. There were two superficial infections. This analysis indicates that posterior cervical plating is highly effective; at long-term follow-up review the cervical spine was successfully stabilized in 93% of cases. Plate failure was related to faulty screw placement, failure to include sufficient motion segments, and noncompliance with postoperative orthoses. Halo vest immobilization was unnecessary and supplemental bone grafting was generally not required for recent trauma.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

Anterior cervical arthrodesis using DOC dynamic stabilization implant for improvement in sagittal angulation and controlled settling

2003 ◽  
Vol 98 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Bikash Bose
Keyword(s):  
Anterior Cervical Discectomy ◽  
Related Complication ◽  
Common Procedure ◽  
Content Type ◽  
Cervical Discectomy ◽  
Arm Pain ◽  
Advantages And Disadvantages ◽  
Cervical Spondylotic Radiculopathy ◽  
Donor Graft ◽  
Fine Print

Object. Placing instrumentation in the anterior cervical spine is a common procedure. The bi- and unicortical systems currently available, however, have distinct advantages and disadvantages. The author reports a prospective series in which a new dynamized anterior cervical fixation system was evaluated. Methods. Thirty-seven patients underwent anterior cervical discectomy and fusion in which the DOC ventral cervical stabilization system was used for indications including cervical spondylotic radiculopathy, disc herniation, trauma, and myelopathy. Patients underwent anterior cervical discectomy and interbody fusion and/or corpectomy. Preoperative and postoperative clinical data included assessment of spinal cord and nerve root deficit, function, neck pain, and arm pain. Preoperative and postoperative radiographic data included sagittal angle, translation, and settling of the graft. Fusion status was determined by the presence of trabecular bridging bone on plain anteroposterior and lateral cervical radiographs. At a mean follow-up time of 1.3 years, postoperative neck or arm pain was resolved in 52% of the patients, restriction on function was mild or absent in 88%, and fusion was successful in 80% of patients and 88% of the treated levels. There was one implant-related complication, one significant dysphagia complication, and a 10.8% donor graft site complication rate. Conclusions. The use of this system led to a high percentage of pain relief and radiographic fusion. The sagittal angle was controlled while allowing for graft settling. There were no implant failures.

Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 119-123 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Yoshimasa Mori ◽  
Yukio Uchiyama ◽  
Yoshihisa Kida ◽  
Shigeru Fujitani
Keyword(s):  
Growth Hormone ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Content Type ◽  
The Mean ◽  
Dose Radiation ◽  
Fine Print

Object. The authors conducted a study to determine the long-term results of gamma knife surgery for residual or recurrent growth hormine (GH)—producing pituitary adenomas and to compare the results with those after treatment of other pituitary adenomas. Methods. The series consisted of 67 patients. The mean tumor diameter was 19.2 mm and volume was 5.4 cm3. The mean maximum dose was 35.3 Gy and the mean margin dose was 18.9 Gy. The mean follow-up duration was 63.3 months (range 13–142 months). The tumor resolution rate was 2%, the response rate 68.3%, and the control rate 100%. Growth hormone normalization (GH < 1.0 ng/ml) was found in 4.8%, nearly normal (< 2.0 ng/ml) in 11.9%, significantly decreased (< 5.0 ng/ml) in 23.8%, decreased in 21.4%, unchanged in 21.4%, and increased in 16.7%. Serum insulin-like growth factor (IGF)—1 was significantly decreased (IGF-1 < 400 ng/ml) in 40.7%, decreased in 29.6%, unchanged in 18.5%, and increased in 11.1%, which was almost parallel to the GH changes. Conclusions. Gamma knife surgery was effective and safe for the control of tumors; however, normalization of GH and IGF-1 secretion was difficult to achieve in cases with large tumors and low-dose radiation. Gamma knife radiosurgery is thus indicated for small tumors after surgery or medication therapy when a relatively high-dose radiation is required.

Long-term outcome of anterior decompression and spinal fixation after placement of the Wellesley Wedge for thoracic and lumbar spinal metastasis

2002 ◽  
Vol 96 (1) ◽  
pp. 6-9 ◽  
Author(s):  
David Yen ◽  
Vikas Kuriachan ◽  
Jeff Yach ◽  
Andrew Howard
Keyword(s):  
Selection Process ◽  
Spinal Metastasis ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors assessed the long-term results of anterior decompressive and vertebral body reconstructive surgery in which the Wellesley Wedge was applied in patients with metastatic spinal lesions over the life span of these individuals. Methods. The authors performed a retrospective review of the outcome of 27 consecutively treated patients who underwent surgery for thoracic or lumbar spine metastases. Decompressive surgery was performed via an anterior thoracotomy and/or retroperitoneal approach depending on the level of the lesion. The spine was reconstructed using a U-shaped plate with an interposed methylmethacrylate strut known as the Wellesley Wedge. Results. Thirty percent of patients suffered medical complications whereas 22% experienced postoperative improvement, as reflected by an improved Frankel grade. Used in patients with a variety of primary tumor types, a spectrum of ages and neurological status, and extensive preoperative osseous spinal involvement and deformity, the Wellesley Wedge resulted in spinal stability for the duration of patients' lives in 92%. Conclusions. In this series the patient selection process for surgery was a challenge yet to be solved; however, considering the durability of the Wellesley Wedge itself, the authors will continue to use it in selected patients.

Bilateral vocal cord paralysis following anterior cervical discectomy and fusion

1998 ◽  
Vol 89 (5) ◽  
pp. 839-843 ◽  
Author(s):  
Thomas J. Manski ◽  
Michael D. Wood ◽  
Stewart B. Dunsker
Keyword(s):  
Vocal Cord ◽  
Surgical Procedure ◽  
Vocal Cord Paralysis ◽  
Anterior Cervical Discectomy ◽  
Neurosurgical Procedures ◽  
Bilateral Vocal Cord Paralysis ◽  
Content Type ◽  
Cervical Discectomy ◽  
Unilateral Vocal Cord Paralysis ◽  
Fine Print

✓ The authors report a rare case of bilateral vocal cord paralysis following anterior cervical discectomy and fusion (ACD/F) in a patient who had a preexisting, clinically silent, and unrecognized unilateral vocal cord paralysis from a remote cardiac surgical procedure. The patient, a 41-year-old woman who developed acute respiratory stridor and respiratory insufficiency at the time of extubation after undergoing a C6–7 ACD/F, required emergency reintubation and ventilation. Otolaryngological evaluation revealed bilateral vocal cord paralysis with one vocal cord showing evidence of acute paralysis and the other showing evidence of chronic paralysis. She eventually required a permanent tracheotomy. The patient had undergone previous cardiac surgical procedures to correct Fallot's tetralogy as a neonate and as a child. At those times, there were no recognized symptoms of transient or permanent vocal cord dysfunction. This case emphasizes the importance of identifying patients with preexisting unilateral vocal cord paralysis before performing neurosurgical procedures such as ACD/F, which can place the only functioning vocal cord at risk for paralysis. Guidelines for identifying patients with preexisting unilateral vocal cord paralysis and for modifying the surgical procedure for ACD/F to prevent the catastrophic complication of bilateral vocal cord paralysis are discussed.

Infiltrating ependymomas of the cauda equina

1974 ◽  
Vol 41 (4) ◽  
pp. 446-448 ◽  
Author(s):  
Michael Scott
Keyword(s):  
Cauda Equina ◽  
Conservative Surgery ◽  
Long Term Results ◽  
Content Type ◽  
Radical Removal ◽  
Benign Course ◽  
Fine Print

✓ The author reports the long-term results of combined conservative surgery and radiotherapy in the treatment of three patients with infiltrating papillary ependymomas Of the cauda equina. Seventeen to 20 years later they have relatively minimal complaints and dysfunction. This long benign course emphasizes the folly of attempting radical removal with its potential for serious mutilation of the cauda equina.

CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results

1990 ◽  
Vol 73 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Mohsen Mohadjer ◽  
Rudolf Eggert ◽  
Johannes May ◽  
Lothar Mayfrank
Keyword(s):  
Long Term Results ◽  
Postoperative Phase ◽  
Ct Guided ◽  
Cerebellar Hemorrhage ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Fine Print ◽  
Stereotactic Puncture

✓ The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.

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