approaches, 1 , 20 , 29 , 30 , 34 with and without instrumentation, have been advocated to achieve an adequate decompression of the spinal cord, restore or maintain sagittal alignment, and avoid kyphosis. Although isolated anterior pathologies can be treated adequately using an anterior approach, 13 , 48 the extension of the pathology over many vertebral levels can require a posterior approach. 26 , 37 The development of postlaminectomy kyphotic deformities 36 lead to different modifications of posterior decompressive techniques, such as laminoplasty or laminectomy
Mario Cabraja, Alexander Abbushi, Daniel Koeppen, Stefan Kroppenstedt and Christian Woiciechowsky
J. Patrick Johnson, Carl Lauryssen, Helen O. Cambron, Robert Pashman, John J. Regan, Neel Anand and Robert Bray
The authors evaluated cervical spine radiographs to determine sagittal alignment in patients who underwent one- or two-level arthroplasty with the Bryan cervical artificial disc prosthesis.
The curvature of the surgically treated spinal segments and the overall curvature of the cervical spine were evaluated in 13 patients who underwent 16 cervical arthroplasty device placements. Preoperative and postoperative lateral radiographs were reviewed and compared using standardized techniques for measuring spinal curvature. Patients who underwent a single-level cervical arthroplasty had a 4.7° mean reduction (p < 0.05) in lordosis after cervical artificial disc replacement. The three patients who underwent two-level cervical arthroplasty had no significant changes in the sagittal alignment.
Patients who underwent arthroplasty with a Bryan cervical artificial disc had a focal loss of lordosis (that is, kyphosis) at the treated levels after single-level procedures. Nevertheless, there was no significant change in the overall sagittal curvature of the cervical spine after single-level artificial disc replacements. The patients who underwent two-level artificial disc placement had no significant changes in lordosis at the treated levels or in the overall curvature. The likely source of this outcome appears to be the endplate milling procedures that reorient the vertebral endplates.
Lali Sekhon and Neil Duggal
Søren Ohrt-Nissen, Casper Dragsted, Benny Dahl, John A. I. Ferguson and Martin Gehrchen
with intraoperative correction techniques and the biochemical properties of the rods. 1 , 5 , 11 Various rod insertion techniques have been described to optimize 3D correction, including derotation, cantilever reduction, translation, and in situ rod bending, but none of these have shown a consistent positive effect on sagittal alignment. 7 , 17 , 27 , 37 Recently, a study assessed the effect of increasing rod strength by introducing bilateral beam-like rods (BRs), which have a larger anteroposterior (AP) diameter than traditional circular rods ( Fig. 1 ). This
Aria Nouri, Allan R. Martin, David Mikulis and Michael G. Fehlings
can be helpful, particularly if anterior surgical decompression is being contemplated and the LF contributes substantially to cord compression. Sagittal Alignment It is becoming increasingly recognized that sagittal alignment might be a contributor to disease severity in patients with DCM and is certainly an important factor in the selection of an anterior or posterior surgical approach. 4 , 68 Therefore, assessment of the cervical spine should include evaluation for scoliosis, hyperlordosis, and kyphosis. Sagittal balance and alignment can be assessed
Deshpande V. Rajakumar, Akshay Hari, Murali Krishna, Subhas Konar and Ankit Sharma
postoperative flexion/extension lateral radiographs measuring Cobb angle (overall cervical sagittal alignment expressed as the C2–7 angle), functional spinal unit (FSU) angle, and range of motion (ROM). Kyphosis was represented by a negative value and lordosis by a positive value. Standard operative techniques were used as described elsewhere. 20 After induction of general anesthesia, surgery was performed in the neutral supine position under fluoroscopic guidance. No collar therapy was necessary postoperatively. The patients were given analgesics and 3 doses of
Sandi Lam and Larry T. Khoo
Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat persistently symptomatic vertebral compression fractures (VCFs). Both interventions usually involve injection of polymethyl methacrylate (PMMA). The purpose of this technical note was to review the theory and surgical technique for a novel percutaneous system for fracture reduction and stabilization of VCFs by using bone graft.
This technical note highlights the Optimesh system as an alternative method of minimally invasive VCF reduction and stabilization with the delivery of a bone graft containment device. Instead of using PMMA as in vertebroplasty or kyphoplasty, this system allows the delivery of allograft and/or autograft bone, with its osteoinductive, osteoconductive, and osteogenic properties.
This system allows for restoration of sagittal alignment of the spine with direct control of bone graft delivery by using a mesh graft containment device that allows for ingrowth of new bone and vascular tissue.
H. Gordon Deen, Jaime Aranda-Michel, Ronald Reimer and John D. Putzke
Organ transplant recipients are at risk for vertebral compression fractures (VCFs). The goal of this study was to determine whether kyphoplasty is an effective treatment for VCFs that develop in this patient population.
Six consecutive patients who had undergone an organ transplant (five liver and one kidney transplant) had a total of 13 symptomatic VCFs that were treated with balloon kyphoplasty. Postprocedure follow-up duration ranged from 6 to 12 months. The mean visual analog scale pain score was 9.3 before treatment and declined to 1.8 after treatment. This improvement was highly significant (p < 0.001). Intake of narcotic drugs decreased or was eliminated in all patients, and there were no complications related to the procedure. There was one instance of clinically insignificant extraosseous cement extravasation. Sagittal alignment was improved by 5° in one patient and was unchanged in the remaining five. During the follow-up period, a new fracture developed adjacent to a treated level in one patient. This was successfully treated with an additional kyphoplasty procedure.
Kyphoplasty can be performed safely in organ transplant recipients with VCF, in whom results are just as favorable as those seen in patients with no history of organ transplantation.