etiology (three patients), all with low thoracic tumors; a radicular pain which was probably due to scar adhesions (three); a dysesthetic root injury pain (two); and neuropathic pain in the lower part of the body due to a spinal cord lesion (one). This last patient received an epidural stimulator as pain treatment. A common finding noted in seven of nine patients was a history of delay in diagnosis: three had been operated on in vain, two unsuccessfully treated for a suspected medical condition, and two for a suspected degenerative spine disorder. One patient, with two
Matti T. Seppälä, Matti J. J. Haltia, Risto J. Sankila, Juha E. Jääskeläinen and Olli Heiskanen
Hans-Ekkehart Vitzthum, Alexander König and Volker Seifert
Object. The aim of this study was to determine the relationship of different structures of the lower lumbar spine during interventional movement examination.
Methods. Clinically healthy volunteers and patients suffering from degenerative disorders of the lumbar spine underwent vertical, open magnetic resonance (MR) imaging (0.5 tesla). Three functional patterns of lumbar spine motion were identified in 50 healthy volunteers, (average age 25 years). The authors identified characteristic angles of the facet joints, as measured in the frontal plane. In 50 patients with degenerative disorders of the lumbar spine (41 with disc herniation, five with osteogenic spinal stenosis, and four with degenerative spondylolisthesis) the range of rotation was increased in the relevant spinal segments. Signs of neural compression were increased under motion.
Conclusions. Dynamic examination in which vertical, open MR imaging is used demonstrated that the extent of neural compression as well as the increasing range of rotation are important signs of segmental instability.
Joachim K. Krauss, Thomas J. Loher, Ralf Weigel, H. Holger Capelle, Sabine Weber and Jean-Marc Burgunder
four patients with generalized choreoathetosis had all suffered from their movement disorders since infancy. They all had received a diagnosis of infantile cerebral palsy of various origins, although no cause could be identified in the patient in Case 5. Their dystonic postures and choreoathetoid movements became progressively worse over the years. The patients in Cases 3 through 5 were wheelchair-bound at the time of surgery. Secondary degenerative spine disorders were present in two patients who also underwent spinal surgery. Multilevel cervical laminectomies for
Jangbo Lee, Izumi Koyanagi, Kazutoshi Hida, Toshitaka Seki, Yoshinobu Iwasaki and Kenji Mitsumori
edema caused by chronic compressive effects. Magnetic resonance imaging enhancement of the spinal cord following administration of Gd has been reported in neoplastic lesions, demyelinating disorders, 14 acute transverse myelitis, 3, 21 or acute spinal cord injury. 23, 27 Although there have been no systemic studies involving Gd-enhanced MR imaging in patients with cervical spondylotic myelopathy, we found it unusual that the compressed spinal cord was enhanced by Gd in chronic degenerative spine disorders. Axial Gd-enhanced MR imaging revealed that the white
Kirsten Schmieder, Annette Kettner, Christopher Brenke, Albrecht Harders, Ioannis Pechlivanis and Hans-Joachim Wilke
Degenerative spine disorders are, in the majority of cases, treated with ventral discectomy followed by fusion (also known as anterior cervical discectomy and fusion). Currently, nonfusion strategies are gaining broader acceptance. The introduction of cervical disc prosthetic devices was a natural consequence of this development. Jho proposed anterior uncoforaminotomy as an alternative motion-preserving procedure at the cervical spine. The clinical results in the literature are controversial, with one focus of disagreement being the impact of the procedure on stability. The aim of this study was to address the changes in spinal stability after uncoforaminotomy.
Six spinal motion segments derived from three fresh-frozen human cervical spine specimens (C2–7) were tested. The donors were two men whose ages at death were 59 and 80 years and one woman whose age was 80 years. Bone mineral density in C-3 ranged from 155 to 175 mg/cm3. The lower part of the segment was rigidly fixed in the spine tester, whereas the upper part was fixed in gimbals with integrated stepper motors. Pure moment loads of ± 2.5 Nm were applied in flexion/extension, axial rotation, and lateral bending. For each specimen a load-deformation curve, the range of motion (ROM), and the neutral zone (NZ) for negative and positive directions of motion were calculated. Median, maximum, and minimum values were calculated for the six segments and normalized to the intact segment. Tests were done on the intact segment, after unilateral uncoforaminotomy, and after bilateral uncoforaminotomy.
In lateral bending a strong increase in ROM and NZ was detectable after unilateral uncoforaminotomy on the right side. Overall, the ROM during flexion/extension was less influenced after uncoforaminotomy. The ROM and NZ during axial rotation to the left increased strongly after right unilateral uncoforaminotomy. Changes after bilateral uncoforaminotomy were marked during axial rotation to both sides.
Following unilateral uncoforaminotomy, a significant alteration in mobility of the segment is found, especially during lateral bending and axial rotation. The resulting increase in mobility is less pronounced during flexion and least evident on extension. Further investigations of the natural course of disc degeneration and the impact on mobility after uncoforaminotomy are needed.
Patrick C. Hsieh, Tyler R. Koski, Daniel M. Sciubba, Dave J. Moller, Brian A. O'shaughnessy, Khan W. Li, Ziya L. Gokaslan, Stephen L. Ondra, Richard G. Fessler, and John C. Liu
Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. In particular, MIS is now routinely used in the treatment of degenerative spine disorders and has been shown to be as effective as conventional open spine surgeries. Although the procedures are not yet widely recognized in the context of complex spine surgery, the true potential in minimizing approach-related morbidity is far greater in the treatment of complex spinal diseases such as spinal trauma, spinal deformities, and spinal oncology. Conventional open spine surgeries for complex spinal disorders are often associated with significant soft tissue disruption, blood loss, prolonged recovery time, and postsurgical pain. In this article the authors review numerous cases of complex spine disorders managed with MIS techniques and discuss the current and future implications of these approaches for complex spinal pathologies.
Leah Y. Carreon, Kelly R. Bratcher, Chelsea E. Canan, Lauren O. Burke, Mladen Djurasovic and Steven D. Glassman
improvement. Thus, the purpose of this study is to determine if MCID values for ODI, SF-36, and back and leg pain are different between patients undergoing primary and revision lumbar fusion procedures. Methods After the present study received Institutional Review Board approval, patients who had decompression and instrumented lumbar fusion for lumbar degenerative spine disorders who had complete baseline and 1-year postoperative ODI, 7 SF-36, 24 and numeric rating scales (0–10) for back and leg pain 15 were identified. All questionnaires were completed by the
Abstracts of the 2013 Annual Meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves
Phoenix, Arizona • March 6–9, 2013
of U.S. population. Lumbar spine surgery leads to significant QALY gains compared to other surgical procedures, highlighting the high utility and value of lumbar spine surgery compared to other common surgical procedures. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2013.3.FOC-DSPNABSTRACTS Top Breakout Sessions Oral Poster Abstracts 213. Use of a Prospective Web-based Registry to Determine the Relative Value of Surgical and Medical Treatments of Degenerative Spine
Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Michael W. Groff, Jeffrey C. Wang, Sanjay S. Dhall and Michael G. Kaiser
. The SRS-22, for example, appears to be more responsive than the ODI or the SF-36 for evaluating the results of lumbar spinal fusion in patients with degenerative scoliosis. 2 E stablishing whether various functional measures are better suited to assess clinical outcome for a specific degenerative spine disorder will be an important step in the evolution of functional outcome assessment. Acknowledgments We would like to acknowledge the AANS/CNS Joint Guidelines Committee (JGC) for their review, comments, and suggestions; Laura Mitchell, CNS Guidelines Project
Zoher Ghogawala, Robert G. Whitmore, William C. Watters III, Alok Sharan, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Michael W. Groff, Jeffrey C. Wang, Daniel K. Resnick, Sanjay S. Dhall and Michael G. Kaiser
other studies investigating the application of cell-salvage autotransfusion, there are insufficient data to perform a meaningful cost-effectiveness analysis. This study provides Level IV evidence that use of cell-salvage autotransfusion is more costly than normal postoperative transfusion (see Table 1 ). Summary Lumbar fusion for certain degenerative spine disorders can be effective in improving clinical outcomes and long-term quality of life when compared with nonoperative therapy. Comprehensive economic analyses that include long-term clinical outcomes data