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  • Author or Editor: Justin Smith x
  • Journal of Neurosurgery: Spine x
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Christopher I. Shaffrey and Justin S. Smith

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Dean Chou, Justin S. Smith and Cynthia T. Chin

✓The authors describe a case of a discal cyst that resolved almost completely without direct intervention. Discal cysts are rare, with the authors of only a few case reports describing this entity. These reports all identify at least some intervention performed for alleviation of the symptoms, including open surgery, minimally invasive surgery, or percutaneous puncture with aspiration. The authors report on a 35-year-old man with radiculopathy who presented with a discal cyst and was treated with a routine epidural injection and selective nerve root block. Within 5 months, the discal cyst showed dramatic regression on magnetic resonance imaging and the patient’s symptoms improved. The natural history of this pathological entity is unknown, and to the authors’ knowledge this is the first detailed report of the regression of a discal cyst without surgery or aspiration.

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Christopher I. Shaffrey and Justin S. Smith

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Christopher I. Shaffrey and Justin S. Smith

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Justin S. Smith, Kai-Ming Fu, Peter Urban and Christopher I. Shaffrey

Object

Adults with scoliosis often present with neurological symptoms and deficits. However, the incidence of these findings and how they may affect treatment decisions have not been clearly defined. The purpose of this study was to quantify the prevalence of neurological symptoms and deficits in adults with scoliosis presenting to a surgical clinic, and to assess for an association between these factors and the decision to pursue operative treatment.

Methods

In this study, the authors document the Oswestry Disability Index (ODI), radiographic findings, and the incidences of back pain, neurological symptoms (radiculopathy and claudication), and neurological deficits (weakness, myelopathy, and bowel/bladder dysfunction) and correlate these with operative versus nonoperative management. Pain was assessed using the visual analog scale (VAS) score. Of 207 patients, 25% underwent surgery.

Results

Incidences of back pain (VAS score > 0 points) and radiculopathy (VAS score > 0) were 99 and 85%, respectively. The incidences of severe (VAS score > 5) back pain and radiculopathy were 66 and 47%, respectively. Neurological symptoms and deficits included weakness in 8% of patients, claudication in 9%, myelopathy in 1%, and bowel/bladder dysfunction in 3%. Patients with severe radiculopathy had greater mean ODI scores (p < 0.001) and reduced lumbar lordosis (p = 0.04) and were more likely to have de novo scoliosis (p = 0.009). Patients who underwent surgery had higher ODI scores (p < 0.001) and a greater incidence of severe radiculopathy (p = 0.006), weakness (p < 0.001), and neurogenic claudication (p = 0.003). Factors associated with operative management on multivariate analysis included weakness (p < 0.001), severe radiculopathy (p = 0.02), and sagittal imbalance (p = 0.03).

Conclusions

Neurological symptoms and deficits are common among adults with scoliosis. Development of neurological symptoms and/or deficits is strongly associated with the decision to pursue operative treatment.

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Vincent C. Traynelis

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Ching-Jen Chen, Dwight Saulle, Kai-Ming Fu, Justin S. Smith and Christopher I. Shaffrey

Object

This study was undertaken to evaluate the incidence of and risk factors associated with the development of dysphagia following same-day combined anterior-posterior cervical spine surgeries.

Methods

The records of 30 consecutive patients who underwent same-day combined anterior-posterior cervical spine surgery were reviewed. The presence of dysphagia was assessed by a formalized screening protocol using history/clinical presentation and a bedside swallowing test, followed by formal evaluation by speech and language pathologists and/or fiberoptic endoscopic evaluation of swallowing/modified barium swallow when necessary. Age, sex, previous cervical surgeries, diagnoses, duration of procedure, specific vertebral levels and number of levels operated on, degree of sagittal curve correction, use of anterior plate, estimated blood loss, use of recombinant human bone morphogenetic protein-2 (rhBMP-2), and length of hospital stay following procedures were analyzed.

Results

In the immediate postoperative period, 13 patients (43.3%) developed dysphagia. Outpatient follow-up data were available for 11 patients with dysphagia, and within this subset, all cases of dysphagia resolved subjectively within 12 months following surgery. The mean numbers of anterior levels surgically treated in patients with and without dysphagia were 5.1 and 4.0, respectively (p = 0.004). All patients (100%) with dysphagia had an anterior procedure that extended above C-4, compared with 58.8% of patients without dysphagia (p = 0.010). Patients with dysphagia had significantly greater mean correction of C2–7 lordosis than patients without dysphagia (p = 0.020). The postoperative sagittal occiput–C2 angle and the change in this angle were not significantly associated with the occurrence of dysphagia (p = 0.530 and p = 0.711, respectively). Patients with postoperative dysphagia had significantly longer hospital stays than those who did not develop dysphagia (p = 0.004). No other significant difference between the dysphagia and no-dysphagia groups was identified; differences with respect to history of previous anterior cervical surgery (p = 0.141), use of an anterior plate (p = 0.613), and mean length of anterior cervical operative time (p = 0.541) were not significant.

Conclusions

The incidence of dysphagia following combined anterior-posterior cervical surgery in this study was comparable to that of previous reports. The risk factors for dysphagia that were identified in this study were increased number of anterior levels exposed, anterior surgery that extended above C-4, and increased surgical correction of C2–7 lordosis.

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Christopher I. Shaffrey and Justin S. Smith

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Christopher I. Shaffrey and Justin S. Smith

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Justin C. Clark and Curtis A. Dickman