1/7. Impact of longitudinal distance of the cervical spine on the results of expansive open-door laminoplasty.STUDY DESIGN: A retrospective study in patients who underwent expansive open-door laminoplasty (ELAP) for cervical myelopathy and in whom the cervical alignment was nonlordotic at the final follow-up to analyze the correlation between the longitudinal distance of the cervical spine and surgical results. OBJECTIVES: To determine the impact of longitudinal distance of the cervical spine on surgical results of ELAP and to propose a new concept, the redundant spinal cord, that may influence patient selection for ELAP. SUMMARY OF BACKGROUND DATA: Results in many studies have demonstrated that postoperative cervical alignment has significant effect on surgical results, and spines that are malaligned are thought to deteriorate. The current surgical data showed that not all patients with postoperative malalignment had poor surgical results. patients with cervical spondylotic myelopathy (CSM) tended to have better clinical results than those with ossification of the posterior longitudinal ligament (OPLL). methods: Results in 70 patients who underwent ELAP for cervical myelopathy with postoperative cervical malalignment were investigated. The longitudinal distance index (LDI) was defined as the length of a vertical line between the posteroinferior edges of C2 and C7 divided by the anteroposterior diameter of C4 and was measured on lateral neutral radiographs at final follow-up. Correlation between LDI and surgical results represented by Japanese Orthopedic association scores and percentage of recovery were analyzed statistically in each patient. RESULTS: patients with CSM had smaller LDI and better surgical results than those with OPLL. Weak but significant negative correlation was detected between LDI and percentage of recovery, indicating that longitudinal distance of the cervical spine may have some degree of impact on the surgical results of ELAP. CONCLUSION: A decrease in LDI represents shortening of the cervical spine caused by multiple disc degeneration and may influence surgical results of ELAP by inducing redundancy of the spinal cord in patients with postoperative malalignment.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/7. Ten-year follow-up study of lower thoracic hemivertebrae treated by convex fusion and concave distraction.STUDY DESIGN: A retrospective review of patient records with recent clinical and radiologic assessment was conducted. OBJECTIVE: To evaluate the long-term results of fully segmented hemivertebrae treated by convex fusion combined with instrumented concave subcutaneous distraction. SUMMARY OF BACKGROUND DATA: Convex fusion has been described for the treatment of hemivertebrae in children, whereas distraction without fusion has been shown to enhance spinal growth. No long-term follow-up studies have combined these two methods. methods: Between 1986 and 1994, six consecutive patients (5 males and 1 female) with hemivertebrae located at T11 or T12 underwent convex anterior and posterior fusion as well as concave subcutaneous distraction without fusion. RESULTS: The mean age at surgery was 3.4 years. The mean follow-up period was 10.8 years (range, 8-14 years). There was a mean improvement of 41% in the coronal deformity, from a mean angle of 49 degrees before surgery to 29 degrees at the latest follow-up assessment. In four of the cases, this correction was achieved immediately after surgery and did not significantly change despite repeated distraction. The kyphosis improved in three cases, remained unchanged in one case, and deteriorated in two cases. In these two cases, an adjacent wedge vertebra contributed to the kyphotic deformity. CONCLUSIONS: Although growth-mediated correction was seen in only two cases, this procedure could be recommended for children with severe deformities and decompensation in the lower thoracic spine. It is safer than hemivertebra excision, with less risk of spinal cord injury. The concave distraction produces immediate improvement in the coronal balance, such that there is no need to wait for uncertain growth-mediated correction in patients who undergo convex fusion only.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
3/7. Axial myopathy--an unrecognised entity.Axial myopathy (AM) is a rare neuromuscular disorder characterised by selective involvement of the spinal muscles with a bent spine and/or drooping head as leading clinical features. We here report the results of clinical, histopathological, MRI, molecular genetics and electrophysiological investigations carried out on six patients affected by pure axial myopathy. Symptoms appeared within an age range of 35 to 56 years. The first symptoms were difficulty in keeping the trunk and head in an upright position. Both bent spine and dropped head were reduced in a supine position. The disease was slowly progressive. muscle strength examination and muscle imaging revealed involvement of the spinal and neck extensor muscles only. serum CK was normal to slightly increased. EMG and muscle biopsy specimens obtained from spinal muscles showed an advanced chronic myopathic pattern. We conclude that axial myopathy may be much more common than previously thought, because gradual progression of cervical kyphosis may often be explained as a feature of normal ageing or as an associated sign of several neurological disorders and vertebral degeneration diseases.- - - - - - - - - - ranking = 1.5keywords = spinal (Clic here for more details about this article) |
4/7. atrophy of kidney following extra corporeal shock wave lithotripsy of renal calculus in a paraplegic patient with marked spinal curvature.OBJECTIVES: To discuss a rare complication of extra corporeal shock wave lithotripsy (ESWL) of renal calculus in a paraplegic patient, who had marked curvature of thoracic and lumbar spine. DESIGN: A case report of a paraplegic patient, who developed renal atrophy and hypertension after undergoing ESWL of staghorn calculus. SETTING: Regional spinal injuries Centre, Southport and Mersey Regional lithotripsy Unit, Royal Liverpool University Hospital, Liverpool, UK. PARTICIPANT: A 28-year-old male with spina bifida, paraplegia at L-1 level and considerable curvature of spine and tilting of pelvis. METHOD: ESWL was carried out in three sessions by delivering 1934, 1876, and 2025 shock waves respectively. Localisation of the staghorn calculus was difficult because of spinal curvature and pelvic tilt. RESULTS: A follow-up IVU, performed 3 months after last ESWL treatment, revealed no residual stone in the left kidney, apart from a little low-density calcification in the renal parenchyma adjacent to the lower pole calyx. There were no calculi in the left ureter. The left kidney had become small, though still functioning. MAG-3 isotope renogram showed the left kidney to be markedly atrophic. Relative renal function: right kidney, 94%; and left kidney, 6%. He developed hypertension and a laparoscopic left nephrectomy was performed at another hospital. CONCLUSION: Difficulty in localisation of renal calculi for ESWL must be anticipated in spinal bifida and spinal cord injury patients, who have significant spinal curvature. Because of problems in the positioning of a patient with marked curvature of spine and pelvic tilt, and consequent difficulties in accurate localisation of renal calculi for lithotripsy, these patients may be at increased risk of developing renal parenchymal and vascular damage following ESWL.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
5/7. Spinal osteochondroma presenting as atypical spinal curvature: a case report.STUDY DESIGN: The case of an 8-year-old girl with hereditary multiple exostosis presenting with atypical spinal curvature is reported. OBJECTIVE: To describe a case of spinal curvature caused by an osteochondroma, illustrating the need for careful evaluation of patients with hereditary multiple exostosis presenting with "scoliosis." SUMMARY OF BACKGROUND DATA: Osteochondromas have been known to arise in the spinal canal and to present with symptoms of neural compression. Spinal curvature is a rare presenting sign of osteochondromas. methods: The patient's medical and radiographic history is reviewed as well as the medical literature. RESULTS: An 8-year-old girl with hereditary multiple exostosis was referred for possible thoracotomy and anterior decompression of a T4 osteochondroma thought to be causing an atypical "scoliosis." Further examination, review of the radiographs, and computed tomography scan showed a large L4 osteochondroma encroaching on the neural elements. The patient's neurologic symptoms and spinal curvature resolved in the 2 years after surgical excision of the lumbar osteochondroma. CONCLUSIONS: patients with hereditary multiple exostosis and spinal curvature require further diagnostic evaluation to ensure that an osteochondroma in the spinal canal is not the cause of that curvature.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
6/7. Evaluation and treatment of congenital and developmental anomalies of the cervical spine. Invited submission from the Joint Section Meeting on Disorders of the spine and peripheral nerves, March 2004.Congenital and developmental osseous abnormalities of the cervical spine can result in neural compression ranging from the medulla oblongata to the cervicothoracic spinal cord junction. These may present in infancy as scoliosis and even limb weakness. A high index of suspicion is essential. Neurodiagnostic imaging relies on high-resolution computerized tomography (CT) scanning and three-dimensional CT reconstructions as well as magnetic resonance imaging and angiography. The anatomical/physiological CT factors considered when developing a surgical approach are: 1) the stability and reducibility of the lesions; 2) direction and manner of encroachment of the lesion on the neural structures; 3) neural and vascular abnormalities; and 4) growth potential of the affected area. Primary stabilization is required for reducible lesions, whereas irreducible lesions are decompressed in the manner in which encroachment has occurred. Instability, whether present before or after operative intervention, required spinal stabilization. Illustrative examples of this approach are presented.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
7/7. Considerations for focused surgical intervention in the presence of adult spinal deformity.STUDY DESIGN: Case studies, literature review. OBJECTIVES: The goal of this review is to raise awareness and stimulate contributions on this topic. SUMMARY OF BACKGROUND DATA: Surgical management of adult patients presenting with intractable back and leg pain in conjunction with spinal deformity often raises the question of need for curve arthrodesis. Meticulous patient assessment is essential in determining if the deformity underlies patient symptoms. If so, then the deformity must be stabilized according to criteria established in the literature. However, when patient evaluation suggests that the deformity is not the source of symptoms, other surgical options may be considered. These include limited decompression without fusion or decompression with short fusion limited only to the site of pathology. MATERIALS AND methods: Three cases are presented illustrating situations where decompression alone or decompression with short fusion was indicated. RESULTS: When an adult spinal deformity is stable and is not the source of symptoms, symptomatic relief may be provided through limited decompression within the curve but without curve arthrodesis. Similarly, symptomatic pathology arising from levels adjacent to or remote from the deformity may be addressed with short-segment decompression and fusion. CONCLUSIONS: This brief and limited communication reviews some of the pertinent issues and provides several examples of selective surgical treatment options without curve arthrodesis in patients with deformity. These options are typically much smaller surgical undertakings, particularly in adult patients who generally have complicating comorbidities. Little has been published to guide surgical management for these conditions.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |