Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique

2005 ◽  
Vol 3 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Ely Ashkenazi ◽  
Yossi Smorgick ◽  
Nahshon Rand ◽  
Michael A. Millgram ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Late Onset ◽  
Plate Fixation ◽  
Hybrid Technique ◽  
Anterior Decompression ◽  
Fixation Technique ◽  
Content Type ◽  
Local Bone ◽  
Multilevel Cervical Myelopathy ◽  
Fine Print

Object. The authors retrospectively evaluated the safety and efficacy of a decompression and fixation technique in the treatment of patients with multilevel cervical spondylotic myelopathy (CSM). Methods. The authors describe the “hybrid decompression fixation” technique, a procedure involving a combination of corpectomies and discectomies to preserve a vertebra intact within the area of the decompression, thus augmenting mechanical stability. The authors retrospectively reviewed outcomes in 25 patients with multilevel CSM in whom the hybrid technique was performed between 1999 and 2003. Twelve patients underwent a single-level corpectomy and three-level discectomies. In 13 patients a two-level corpectomy and adjacent four-level discectomies were conducted, leaving a vertebral bridge the middle. All patients underwent fusion involving placement of disc and vertebral body cages filled with autogenous local bone and supplemental anterior dynamic plate fixation. The mean preoperative Nurick grade was 3 and improvement in status was reflected by a postoperative decrease to 2.6 (p < 0.05). In one patient neurological deterioration was demonstrated. At the end of the follow-up period (mean 29 months) radiography revealed evidence of osseous fusion in 24 patients; fusion status could not be determined in one patient. No evidence of late-onset instrumentation-related failure was observed in any of the 25 patients. Conclusions. The authors found the hybrid technique to be safe and efficient for anterior decompression in patients with multilevel CSM. The use of this technique obviates the need for staged circumferential procedures.

Posterior atlantoaxial transpedicular screw and plate fixation

2005 ◽  
Vol 2 (3) ◽  
pp. 386-392 ◽  
Author(s):  
Jyi-Feng Chen ◽  
Chieh-Tsai Wu ◽  
Sai-Cheung Lee ◽  
Shih-Tseng Lee
Keyword(s):  
Spinal Deformity ◽  
Plate Fixation ◽  
Atlantoaxial Instability ◽  
Fixation Technique ◽  
Content Type ◽  
Neural Damage ◽  
Transpedicular Screw ◽  
Atlantoaxial Fixation ◽  
Fine Print

✓ The authors describe a modified posterior atlantoaxial fixation technique for the treatment of reducible atlantoaxial instability, which can be performed simply and easily, and can decrease the risk of vessel and/or neural damage. During an 18-month period, this technique was undertaken in 11 patients with atlantoaxial instability. There was no procedure-related morbidity. The follow-up period ranged from 8 to 18 months (mean 13.2 months). Fusion was documented in all 11 patients, and there was no progression of spinal deformity. This technique can be considered an effective alternative in the treatment of atlantoaxial subluxation.

Aspergillus infection complicating transsphenoidal yttrium-90 pituitary implant

1977 ◽  
Vol 46 (4) ◽  
pp. 530-532 ◽  
Author(s):  
Michael Feely ◽  
Marta Steinberg
Keyword(s):  
Cerebrospinal Fluid ◽  
Late Onset ◽  
Content Type ◽  
Aspergillus Infection ◽  
Yttrium 90 ◽  
Fine Print

✓ Diagnosis proved difficult in two cases of Aspergillus infection complicating yttrium-90 ablation of the pituitary. This serious complication occurs rarely. Whatever the initial organism obtained from cases with meningitis of late onset, Aspergillus infection should be considered and cerebrospinal fluid should be cultured for fungi.

Prophylactic phenytoin in severe head injuries

1979 ◽  
Vol 51 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Richard N. W. Wohns ◽  
Allen R. Wyler
Keyword(s):  
Retrospective Study ◽  
Head Injury ◽  
High Probability ◽  
Late Onset ◽  
Head Injuries ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
Fine Print

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

Radiculopathy of C-5 after anterior decompression for cervical myelopathy

2005 ◽  
Vol 3 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Minoru Ikenaga ◽  
Jitsuhiko Shikata ◽  
Chiaki Tanaka
Keyword(s):  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Manual Muscle Testing ◽  
Radiographic Evaluation ◽  
Anterior Decompression ◽  
Content Type ◽  
Muscle Testing ◽  
Anterior Corpectomy ◽  
Fine Print

Object. The authors conducted a study to examine the incidence and causes of postoperative C-5 radiculopathy, and they suggest preventive methods for C-5 palsy after anterior corpectomy and fusion. Methods. The authors included in the study 18 patients with postoperative C-5 radiculopathy from 563 patients who underwent anterior decompression and fusion for cervical myelopathy. There were 10 cases of ossification of the posterior longitudinal ligament (OPLL) and eight cases of cervical spondylotic myelopathy (CSM). All patients received conservative treatment. Posttreatment full recovery was present in eight patients, and Grade 3/5 strength was documented in six in whom some weakness remained. Radiographic evaluation revealed that the C3–4 and C4–5 cord compression was significantly more severe in patients with paralysis than in those without paralysis. The incidence of paralysis was higher in patients with OPLL than in those with CSM (chi-square test, p = 0.03). The incidence of paralysis increased in parallel with the number of fusion levels (correlation coefficient r = 0.94). Multivariate analysis revealed that the final manual muscle testing (MMT) value was closely related to the preoperative MMT value (computed t value 4.17; p < 0.01) and preoperative Japanese Orthopaedic Association (JOA) score for cervical myelopathty (computed t value, 2.75; p < 0.05). Conclusions. Preexisting severe stenosis at C3–4 or C4–5 in patients with OPLL is a risk factor for paralysis. Preoperative muscle weakness and a low JOA score are factors predictive of poor recovery.

Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine

1972 ◽  
Vol 37 (4) ◽  
pp. 493-497 ◽  
Author(s):  
Michael H. Sukoff ◽  
Milton M. Kadin ◽  
Terrance Moran
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Transoral Approach ◽  
Anterior Decompression ◽  
Posterior Decompression ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

✓ A case of rheumatoid cervical myelopathy that responded to posterior decompression and fusion is presented. Progression of the disease ultimately required anterior decompression through a transoral approach.

Late vertebral body fracture after lumbar transpedicular fixation

2005 ◽  
Vol 3 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Paolo Missori ◽  
Alessandro Ramieri ◽  
Giuseppe Costanzo ◽  
Simone Peschillo ◽  
Sergio Paolini ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Late Onset ◽  
Traumatic Injury ◽  
Spinal Instrumentation ◽  
Lumbar Pain ◽  
Content Type ◽  
Transpedicular Fixation ◽  
Body Fracture ◽  
Sharing Function ◽  
Fine Print

✓ Late-onset vertebral body (VB) fracture after lumbar transpedicular fixation has not been previously described in the literature. The authors present three cases in which VB fracture occurred several months after posterolateral fixation in patients with degenerative disease or traumatic injury. The authors suggest that postoperative osteopenia, modified load-sharing function, and intravertebral clefts were responsible for the fractures. Two women and one man were evaluated at a mean follow-up interval of 3 months. Two patients suffered recurrent lumbar pain. Radiography and magnetic resonance imaging revealed fracture of some of the instrumentation-treated VBs. These two patients underwent surgical superior or inferior extension of instrumentation. The third, an asymptomatic patient, received conservative management. The two patients who underwent reoperation made complete recoveries, and there was no evidence of further bone collapse in any case. The authors speculate that alterations in the VBs may occur following application of spinal instrumentation. In rare cases, the device can fracture and consequently lead to recurrent lumbar back pain. Recovery can be achieved by extending the instrumentation in the appropriate direction.

Cervical facet dislocation: techniques for ventral reduction and stabilization

2000 ◽  
Vol 92 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Bernardo J. Ordonez ◽  
Edward C. Benzel ◽  
Sait Naderi ◽  
Simcha J. Weller
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Plate Fixation ◽  
Neurological Status ◽  
Content Type ◽  
Facet Dislocation ◽  
Cord Injury ◽  
Complete Spinal Cord Injury ◽  
Cervical Facet ◽  
Fine Print

Object. To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. Methods. Six patients presented with unilateral cervical facet dislocation and four patients with bilateral cervical facet dislocation. There were six male and four female patients who ranged in age from 17 to 72 years (average 37.1 years). The level of facet dislocation was C4–5 in one, C5–6 in four, and C6–7 in five patients. Three patients presented with a complete spinal cord injury (SCI), three patients with an incomplete SCI, three with radicular symptoms or myeloradiculopathy, and one patient was neurologically intact. All patients underwent plain radiography, magnetic resonance imaging, and computerized tomography evaluation of the cervical spine. All patients had sustained significant ligamentous injury with minimum or no bone disruption. All patients underwent ventral decompressive surgery, reduction of the dislocation, and stabilization of the cervical spine. Techniques for performing ventral reduction of unilateral or bilateral cervical facet dislocation are described. Decompression, reduction, and stabilization of the cervical spine via the ventral approach was accomplished in all but one patient. This patient underwent a ventral decompressive procedure and an attempt at ventral reduction and subsequent dorsal reduction and fusion in which a lateral mass screw plate fixation system was used; this was followed by ventral placement of instrumentation and fusion. There were no surgery-related complications. Postoperative neurological status was unchanged in four patients and improved in six patients. No patient experienced neurological deterioration after undergoing this surgical approach. Conclusions. The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.

The effect of heparin reversal after carotid endarterectomy in the dog

1982 ◽  
Vol 56 (1) ◽  
pp. 97-102 ◽  
Author(s):  
William F. Chandler ◽  
Mark S. Ercius ◽  
John W. Ford ◽  
William E. Burkel
Keyword(s):  
Carotid Endarterectomy ◽  
Arterial Thrombosis ◽  
Vessel Wall ◽  
Fixation Technique ◽  
Content Type ◽  
Systemic Heparinization ◽  
The Media ◽  
Total Coverage ◽  
Fine Print ◽  
Scanning Electron

✓ The purpose of this study was to determine if total reversal of heparin immediately after carotid endarterectomy would have an adverse effect on the thrombogenicity of the endarterectomized vessel wall. After systemic heparinization, unilateral common carotid endarterectomies were performed under the operating microscope on 14 dogs. Half of the animals were given protamine sulfate to reverse the heparin. Three hours after resumption of blood flow, these arteries, as well as contralateral vessels used as controls for fixation technique, were perfused with glutaraldehyde and prepared for scanning electron microscopy (SEM). Thrombin clotting times were measured throughout the experiments. Sections of the endarterectomized portions viewed by SEM showed nearly total coverage of the exposed collagen of the media with flattened platelets. There were scattered leukocytes, but few erythrocytes, little fibrin, and no true thrombus. There were no differences between the animals that received heparin reversal and those that did not. A group of five additional arteries underwent the same procedure except that no heparin was given. As expected, large amount of thrombus had formed within the lumina of these control vessels by 3 hours. Since previous studies suggest that arterial thrombosis usually occurs within 3 hours of endothelial injury, the authors conclude that total reversal of heparin does not increase thrombogenicity of the endarterectomized vessel. This suggests that heparin may be safely reversed in patients to help maintain postoperative hemostasis.

Septic cavernous sinus thrombosis following transsphenoidal craniotomy

1996 ◽  
Vol 85 (5) ◽  
pp. 949-952 ◽  
Author(s):  
Federico Sadun ◽  
Steven E. Feldon ◽  
Martin H. Weiss ◽  
Mark D. Krieger
Keyword(s):  
Antibiotic Therapy ◽  
Cavernous Sinus ◽  
Late Onset ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Broad Spectrum Antibiotic ◽  
Abscess Drainage ◽  
Intravenous Antibiotic ◽  
Content Type ◽  
Fine Print

✓ The authors present a case of late-onset cavernous sinus thrombosis in a 74-year-old man who had undergone transsphenoidal craniotomy for a pituitary macroadenoma 9 weeks previously. The patient developed headache, rapidly progressive ophthalmoplegia, and signs of orbital congestion. After 2 days of ineffective broad spectrum antibiotic therapy he underwent a second transsphenoidal craniotomy for abscess drainage. Intraoperative cultures grew 4+ nonhemolytic Streptococcus, 4+ Staphylococcus coagulase negative, and 4+ Haemophilus influenzae. The patient was maintained on intravenous antibiotic therapy for the following 6 weeks, resulting in a complete clinical recovery. To the authors' knowledge, this is the first report of a septic cavernous sinus thrombosis following a transsphenoidal craniotomy.

Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae

1999 ◽  
Vol 90 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Wolfhard Caspar ◽  
Tobias Pitzen ◽  
Luca Papavero ◽  
Fred H. Geisler ◽  
Todd A. Johnson
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Bone Graft ◽  
Mechanical Stability ◽  
Cervical Vertebrae ◽  
Autologous Bone Graft ◽  
Retrospective Case ◽  
Content Type ◽  
Fine Print

Object. To assess clinical outcome and survival in patients with cervical vertebral spinal neoplasms after they have undergone anterior decompression and cervical plate stabilization (ACPS) by using either autologous bone graft or polymethylmethacrylate (PMMA) as the anterior load-bearing support structure. Methods. This was a retrospective case study composed of 30 patients harboring cervical spinal vertebral neoplasms who underwent anterior cervical decompression and (ACPS) within a 7-year period. Postoperative immobilization included treatment in a halo brace in two cases and in a hard cervical collar for the remaining patients. Postoperatively most patients underwent radio- and/or chemotherapy. All patients except one benefited from a significantly improved quality of life with decreased pain and/or improved neurological status. The mean Kaplan—Meier survivoral estimate was 35.8 months (range 8 days–11.3 years, with 10 patients alive at most recent follow-up contact). Patients achieved long-term or lifelong mechanical stability in the cervical spine, and only one patient required a repeated posterior stabilization procedure. No hardware-related complications occurred. One patient died 8 days postoperatively of pneumonia. A nonsignificant difference in survival (p = 0.2164) was observed between patients harboring metastatic neoplasms (26.8 months) and those harboring lymphomatous and multiple myeloma neoplasms (54 months). Conclusions. Favorable clinical outcome of both neurological symptoms and pain can be achieved using ACPS after surgery for neoplasms in the cervical vertebrae. Furthermore, long-term or lifelong cervical spine mechanical stability with bone fusion is achieved using this technique even when radiation therapy is delivered to the site of the bone graft.

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