BACKGROUND: Anterior interbody fusion has previously been demonstrated to increase neuroforaminal height in a cadaveric model using cages. No prior study has prospectively assessed the relative change in magnetic resonance imaging (MRI) demonstrated neuroforaminal dimensions at the index and supradjacent levels, after anterior interbody fusion with a corticocancellous allograft in a series of patients without posterior decompression. The objective of this study was to determine how much foraminal dimension can be increased with indirect foraminal decompression alone via anterior interbody fusion, and to determine the effect of anterior lumbar interbody fusion on the dimensions of the supradjacent neuroforamina. METHODS: A prospective study comparing pre- and postoperative neuroforaminal dimensions on MRI scan among 26 consecutive patients undergoing anterior lumbar interbody fusion without posterior decompression was performed. We studies 26 consecutive patients (50 index levels) that had undergone anterior interbody fusion followed by posterior pedicle screw fixation without distraction or foraminotomy. We used preoperative and postoperative MRI imaging to assess the foraminal dimensions at each operated level on which the lumbar spine had been operated. The relative indirect foraminal decompression achieved was calculated. The foraminal dimension of the 26 supradjacent untreated levels was measured pre- and postoperatively to serve as a control and to determine any effects after anterior interbody fusion. RESULTS: In this study, 8 patients underwent 1 level fusion (L5-S1), 12 patients had 2 levels (L4-S1) and 6 patients had 3 levels (L3-S1). The average increase in foraminal dimension was 43.3% (p < 0.05)-19.2% for L3-4, 57.1% for L4-5, and 40.1% for L5-S1. Mean pre- and postoperative supradjacent neuroforaminal dimension measurements were 125.84 mm2 and 124.89 mm2, respectively. No significant difference was noted (p > 0.05). CONCLUSIONS: Anterior interbody fusion with a coriticocancellous allograft can significantly increase neuroforaminal dimension even in the absence of formal posterior distraction or foraminotomy; anterior interbody fusion with a coriticocancellous allograft has little effect on supradjacent neuroforaminal dimensions.
Female ; Humans ; Intervertebral Disc Degeneration/*diagnosis/surgery ; *Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; *Spinal Fusion

OBJECTIVETo explore the etiopathogenisis, diagnosis and early treatment of postoperative pyogenic infection in patients with lumbar disc diseases.

METHODSFrom March 2009 to March 2012,7 patients with postoperative pyogenic infection were retrospectivly analyzed. There were 6 males and 1 female,ranging in age from 42 to 62 years old,with an average of 46.5 years old. Among 7 cases,outside the spinal canal suppurative infection occurred in 6 cases and inside the spinal canal infection in 1 case and with temporary paralysis. All the patients were treated with continuous saline lavage-drainage of low pressure impulse during operation. Unitive sensitive antibiotics were applied for 4-6 weeks after operation until CRP and ESR completely normal or the biochemistry and routine examination of the cerebrospinal fluid completely normal for the patients with intracranial pyogenic infection.

RESULTSAll the 7 cases obtained recovery and the length of stay was for 2-3 months. No remnant symptoms of nervous system were found at the leave hospital.

CONCLUSIONPostoperative pyogenic infection in patients with lumbar disc diseases is an emergency,and easily results in misdiagnosis in clinic. So the early diagnosis is very important. Early debridement is the only measure to retrieve the life of patient,continuous saline lavage-drainage of low pressure impulse may remove the remnant focus of the deep soft tissue space,and removel of the internal fixation can ensure the postoperative pyogenic infection completely control.

Adult ; Bacterial Infections ; diagnosis ; therapy ; Debridement ; Early Intervention (Education) ; Female ; Humans ; Intervertebral Disc Degeneration ; surgery ; Intervertebral Disc Displacement ; surgery ; Length of Stay ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; therapy ; Retrospective Studies

BACKGROUNDAdjacent segment disease (ASD) is common after cervical fusion. The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).

METHODSPatients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion. A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments. Plate-to-disc distances (PDDs), developmental cervical canal stenosis on X-ray, cervical disc degeneration grading, and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.

RESULTSThirty-four patients with complete radiographic data were included in the ASD group. The causative segments of ASD included nine cases of C3-4, 18 cases of C4-5, three cases of C5-6, and four cases of C6-7. The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients. PDD distributions were similar between the ASD group and the control group. Developmental cervical canal stenosis was a risk factor for ASD, with an odd ratio value of 2.88. Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group. In the upper-level ASD group, the disc bulge impingement was (19.7±9.7)%, which was significantly higher than that of the control group of (11.8±4.8)%.

CONCLUSIONSASD was more likely to develop above the index level of fusion. Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.

Cervical Vertebrae ; pathology ; surgery ; Decompression, Surgical ; adverse effects ; Humans ; Intervertebral Disc Degeneration ; diagnosis ; etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Risk Factors ; Spinal Fusion ; adverse effects ; Spinal Stenosis ; diagnostic imaging