Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system

2000 ◽  
Vol 92 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Kuniyoshi Abumi ◽  
Yasuhiro Shono ◽  
Yoshihisa Kotani ◽  
Kiyoshi Kaneda
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Disc Herniation ◽  
Herniated Disc ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Cervical Pedicle Screw ◽  
Cervical Pedicle ◽  
Fine Print

Object. In this study the authors retrospectively review 16 patients with traumatic disc herniation secondary to middle and lower cervical spine injuries who underwent a single posterior reduction and fusion procedure in which a cervical pedicle screw system was used. The study was undertaken to evaluate whether the procedure effectively reduced the disc herniation and whether it can be safely conducted without performing anterior decompressive surgery. Methods. A total of 73 patients with middle and lower cervical spine injuries were identified. In 50 patients, pre- and postoperative magnetic resonance (MR) images were obtained, and disc herniation was defined as the presence of an extruded disc that deformed the thecal sac or nerve roots. Traumatic disc herniation was revealed in 16 patients (32%) who underwent a single posterior reduction/fusion procedure in which a cervical pedicle screw system was used. The average follow-up period was 4.25 years (2–6.25 years). In all patients the average kyphotic deformity was 18°, which was corrected to 0.7° lordosis postoperatively. Anterior translation was reduced from 8 to 0.7 mm. The preoperative disc height ratio of 63% (normal 100%) was improved to 104%. Preoperative MR images revealed traumatic disc herniation in all 16 patients; postsurgery, reduction or reversal of disc herniation was observed in all patients. Thecal sac and/or spinal cord compression had disappeared after indirect decompression was achieved using a posterior procedure. No additional decompressive procedures were required to remove residual herniated disc material. Preoperatively, four patients presented with cervical radiculopathy, 10 with myelopathy (eight incomplete and two complete), and two without neurological symptoms. At final follow up, complete recovery was observed in all four patients with radiculopathy and improvement of at least one Frankel grade was shown in six patients (60%) with myelopathy. There were no cases of neurological deterioration immediately after surgery or during the course of the follow-up period. In all patients solid bone union was demonstrated, and there were no implant-related complications. Conclusions. Traumatic disc herniation may occur frequently in association with injury of the cervical spine. The incidence of traumatic disc herniation in our series was 32%. The cervical pedicle screw system allowed three-dimensional reduction of the injured cervical segment and reduction or reversal of a disc herniation. After surgery, compression of the thecal sac and/or spinal cord had disappeared. The cervical pedicle screw system provides effective and safe fixation of the cervical spine injury—related traumatic disc herniation, and the surgery can be performed safely in a single posteriorapproach procedure without need of additional anterior decompressive interventions.

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
Author(s):  
Eddy Garrido ◽  
P. Noel Connaughton
Keyword(s):  
Disc Herniation ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Content Type ◽  
X Ray ◽  
Flexion And Extension ◽  
Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

scholarly journals Improved accuracy of computer-assisted cervical pedicle screw insertion

2003 ◽  
Vol 99 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Yoshihisa Kotani ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Akio Minami
Keyword(s):  
Real Time ◽  
Pedicle Screw ◽  
Computer Assisted ◽  
Insertion Technique ◽  
Content Type ◽  
Cervical Pedicle Screw ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Cervical Pedicle ◽  
Fine Print

Object. The authors introduce a unique computer-assisted cervical pedicle screw (CPS) insertion technique used in conjunction with specially modified original pedicle screw insertion instruments. The accuracy of screw placement as well as surgery-related outcome and complication rates were compared between two groups of patients: those in whom a computer-assisted and those in whom a conventional manual insertion technique was used. Methods. The screw insertion guiding system consisted of a modified awl, probe, tap and a screwdriver specially designed for a computer-assisted CPS insertion. Using this system, real-time instrument/screw tip information was three dimensionally identified in each step of screw insertion. Seventeen patients underwent CPS fixation in which a computer-assisted surgical navigation system was used. The cervical disorders consisted of spondylotic myelopathy with segmental instability or kyphosis, metastatic spinal tumor, rheumatoid spine, and postlaminectomy kyphosis. The rate of pedicle wall perforation was significantly lower in the computer-assisted group than that in the other group (1.2 and 6.7%, respectively; p < 0.05). The screw trajectory in the horizontal plane was significantly closer to the anatomical pedicle axis in the computer-assisted group compared with the manual insertion group (p < 0.05). This factor significantly reduced the incidence of screw perforation laterally. Complications such as neural damage or vascular injury were not demonstrated in the computer-assisted group (compared with 2% in the manual insertion treatment group). The overall surgery-related outcome was satisfactory. Conclusions. In contrast to the previously reported computer-assisted technique, our CPS insertion technique provides real-time three-dimensional instrument/screw tip information. This serves as a powerful tool for safe and accurate pedicle screw placement in the cervical spine.

Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation

1993 ◽  
Vol 79 (3) ◽  
pp. 341-345 ◽  
Author(s):  
Stephen E. Doran ◽  
Stephen M. Papadopoulos ◽  
Thomas B. Ducker ◽  
Kevin O. Lillehei
Keyword(s):  
Cervical Spine ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Clinical Status ◽  
Cord Compression ◽  
Herniated Disc ◽  
Content Type ◽  
Fine Print

✓ The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) or bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation. This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered. anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.

Prognostic significance of magnetic resonance imaging in the acute phase of cervical spine injury

1992 ◽  
Vol 76 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Dale M. Schaefer ◽  
Adam E. Flanders ◽  
Jewell L. Osterholm ◽  
Bruce E. Northrup
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Prognostic Significance ◽  
Spinal Segment ◽  
Content Type ◽  
Group 3 ◽  
Group 2 ◽  
Fine Print ◽  
Group 1

✓ Fifty-seven patients with acute cervical spine injuries and associated major neurological deficit were examined within 2 weeks of injury by magnetic resonance (MR) imaging. All patients had abnormal scans, indicating intramedullary lesions. This study was undertaken to determine if the early MR imaging pattern had a prognostic relationship to the eventual neurological outcome. Three different MR imaging patterns were observed in these patients: 21 patients had patterns characteristic of intramedullary hematoma (Group 1); 17 had intramedullary edema over more than one spinal segment, but no hemorrhage (Group 2); and 19 had restricted zones of intramedullary edema involving one spinal segment or less (Group 3). The neurological state was determined using standard motor index scores at admission and at follow-up examination. Characteristically, the patients in Group 1 had admission motor scores significantly lower than the other two groups. At follow-up examination, the median percent motor recovery was 9% for Group 1, 41% for Group 2, and 72% for Group 3. These studies suggest that the MR imaging pattern observed in the acutely injured human spinal cord has a prognostic significance in the final outcome of the motor system. It is only when an accurate prognosis can be given at the outset that useful treatment data might be collected for homogeneous injury groups, and accurately based long-term planning made for the best patient care.

Clinical outcomes and complications associated with pedicle screw fixation—augmented lumbar interbody fusion

2004 ◽  
Vol 1 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Dennis J. Rivet ◽  
David Jeck ◽  
James Brennan ◽  
Adrian Epstein ◽  
Carl Lauryssen
Keyword(s):  
Carbon Fiber ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Repeated Surgery ◽  
Fine Print

Object. The authors conducted a prospective study to evaluate the clinical and radiological outcomes and complications associated with uni- and bilateral transforaminal lumbar interbody fusion (TLIF) performed using carbon fiber Brantigan I/F Cages and pedicle screw fixation. Methods. Forty-two consecutive patients who had undergone uni- or bilateral TLIF between February 1999 and July 2000 were prospectively evaluated. Clinical outcome was graded using a modified Prolo Scale, the McGill Pain Index Scale, a follow-up questionnaire, and charts. An independent radiologist assessed radiological outcomes. All patients were followed for at least 1 year. Based on Prolo Scale scores, an excellent or good 1-year outcome was achieved in 73% of patients; 90% of patients responded that they would undergo the procedure again. At 1 year, radiographic fusion was demonstrated in 74% and was statistically related to clinical outcome (p < 0.05). There were no deaths or major hardware failures. Complications requiring repeated surgery included one case of cerebrospinal fluid (CSF) leakage and one case in which the hemovac drain was retained. There were four cases involving minor wound infections, eight involving CSF leaks, and none requiring repeated surgery. On routine follow-up radiography one pedicle screw was found to be broken; the patient remained asymptomatic and fusion occurred. Conclusions. Unilateral and bilateral TLIF involving placement of carbon fiber cages and pedicle screw fixation are effective treatment options in patients with indications for lumbar arthrodesis. The procedures result in acceptable rates of fusion and clinical success, and a minimal incidence of morbidity when performed by an experienced surgeon.

Syndrome of the incidental herniated lumbar disc

1983 ◽  
Vol 59 (1) ◽  
pp. 137-141 ◽  
Author(s):  
James E. Wilberger ◽  
Dachling Pang
Keyword(s):  
Clinical Features ◽  
Lumbar Disc Herniation ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Appropriate Treatment ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.

Minimally invasive transforaminal lumbar interbody fusion with ipsilateral pedicle screw and contralateral facet screw fixation

2005 ◽  
Vol 3 (3) ◽  
pp. 218-223 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
The Mean ◽  
Level Fusion ◽  
Fine Print

Object. The purpose of this study was to introduce a minimally invasive transforaminal lumbar interbody fusion (TLIF) technique that involves ipsilateral pedicle screw (PS) and contralateral facet screw (FS) fixation. Methods. Eight men and 15 women (mean age 59.5 years, range 48–68) underwent the aforementioned TLIF procedure for degenerative spondylolisthesis and uni- or bilateral radiculopathy. Twenty-two patients underwent one-level fusion and one patient two-level fusion (L4—S1). In all cases the various procedures were undertaken via one small incision. There were no intraoperative complications. The mean estimated blood loss (EBL) was 310 ml, and the mean operative time was 150 minutes in cases of one-level fusion. The follow-up period ranged from 13 to 28 months (mean 19 months). The mean Numeric Rating Scale score reflected improvement-reductions from 7.5 (back pain) and 7.4 (leg pain) to 2.3 and 0.7, respectively (p < 0.0001). The mean Oswestry Disability Index (ODI) scores also reflected improved status (ODI of 33.1 before the surgery to 7.6 after the surgery; p < 0.0001). Examination indicated that 22 of 24 fusion sites exhibited osseous union. At the last follow-up examination, satisfactory outcomes were observed in 21 out of 23 patients. Conclusions. The TLIF with ipsilateral PS and contralateral FS fixation has the advantages over the conventional TLIF of reduced EBL and diminished soft-tissue injury.

Spontaneous intracranial hypotension due to thoracic disc herniation

2002 ◽  
Vol 96 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Stuart C. A. Winter ◽  
Nicholas F. Maartens ◽  
Philip Anslow ◽  
Peter J. Teddy
Keyword(s):  
Disc Herniation ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Herniated Disc ◽  
Subdural Effusion ◽  
Thoracic Disc Herniation ◽  
Content Type ◽  
Blood Patch ◽  
Thoracic Disc ◽  
Fine Print

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit. Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.

Xeroradiography in evaluation of cervical spine injuries

1978 ◽  
Vol 49 (4) ◽  
pp. 620-621
Author(s):  
Norman D. Peters ◽  
George Ehni
Keyword(s):  
Cervical Spine ◽  
Lower Cervical Spine ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Fine Print

✓ Xeroradiography is a useful tool in the evaluation of fractures and dislocation of the lower cervical spine. It affords clear visualization with minimal manipulation or risk.

Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

1998 ◽  
Vol 89 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Manucher J. Javid ◽  
Eldad J. Hadar
Keyword(s):  
Success Rate ◽  
Herniated Disc ◽  
Lumbar Stenosis ◽  
Content Type ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Significant Difference ◽  
Fine Print

Object. Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis. Methods. Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1% at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis. Conclusions. In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

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