At times lumbar disc herniations present a quandary to the spine surgeon in regards to the most appropriate intervention and a need to optimize medical and surgical therapies. We discuss a case of ours and our experience in treating this common spinal pathology, along with a commentary on the article published by Kim et al. entitled 'Spontaneous regression of extruded lumbar disc herniation: three cases report in Korean J Spine. 2013 Jun;10(2):78-81.'
Pathology ; Patient Selection* ; Spine

For a thoracolumbar junction lesion, there are many approaches according to pathology. A combined anterior and posterior approach can give anterior and posterior fixation with adequate neural decompression in three column lesion like a metastatic tumor or primary malignant lesion. But it can cause a serious complication of vascular or visceral injury especially during anterior approach. Author developed a new approach which can give a rigid fixation at anterior and posterior column simultaneously by posterior approach. This method has advantages of both anterior and posterior approach and associated with minimized postoperative morbidity. By this method good three column stabilization and adequate neural decompression can be achieved immediately. Three cases of malignant spinal tumors and two cases of complicated spine fracture were operated by this approach. Among three tumor cases, two patients showed rapid recovery of their impending paraparesis. All patients had excellent clinical results and good stabilities of spinal column without any complications.
Decompression ; Humans ; Paraparesis ; Pathology ; Spine

OBJECTIVE: This study was designed to determine the most reliable cephalometric measurement technique in the normal population and patients with basilar invagination (BI). METHODS: Twenty-two lateral radiographs of BI patients and 25 lateral cervical radiographs of the age, sex-matched normal population were selected and measured on two separate occasions by three spine surgeons using six different measurements. Statistical analysis including intraclass correlation coefficient (ICC) was carried out using the SPSS software (V. 12.0). RESULTS: Redlund-Johnell and Modified (M)-Ranawat had a highest ICC score in both the normal and BI groups in the inter-observer study. The M-Ranawat method (0.83) had a highest ICC score in the normal group, and the Redlund-Johenll method (0.80) had a highest ICC score in the BI group in the intra-observer test. The McGregor line had a lowest ICC score and a poor ICC grade in both groups in the intra-observer study. Generally, the measurement method using the odontoid process did not produce consistent results due to inter and intra-observer differences in determining the position of the odontoid tip. Opisthion and caudal point of the occipital midline curve are somewhat ambiguous landmarks, which induce variable ICC scores. CONCLUSION: On the contrary to other studies, Ranawat method had a lower ICC score in the inter-observer study. C2 end-plate and C1 arch can be the most reliable anatomical landmarks.
Humans ; Odontoid Process ; Pathology* ; Spine

Cervical corpectomy is a viable technique for the treatment of multilevel cervical spine pathology. Despite multiple advances in both surgical technique and implant technology, the rate of construct subsidence can range from 6% for single-level procedures to 71% for multilevel procedures. In this technical note, we describe a novel technique, the bump-stop technique, for cervical corpectomy. The technique positions the superior and inferior screw holes such that the vertebral bodies bisect them. This allows for fixation in the dense cortical bone of the endplate while providing a buttress to corpectomy cage subsidence. We then discuss a retrospective case review of 24 consecutive patients, who were treated using this approach, demonstrating a lower than previously reported cage subsidence rate.
Humans ; Pathology ; Retrospective Studies ; Spine

Adult ; Bone Neoplasms ; pathology ; Humans ; Lymphoma ; pathology ; Male ; Spine ; pathology

Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achieved with meticulous preoperative analysis of the pathology, good patient selection for a specific procedure and careful execution of the surgery. Cervical spine surgery is usually effective in treating most pathologies and only a reasonable complication rate exists.
Pathology ; Patient Positioning ; Patient Selection ; Spine*

This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.
Cognition ; Diskectomy ; Humans ; Pathology ; Reaction Time ; Spine

Child ; Female ; Humans ; Sarcoma, Myeloid ; Spine ; pathology

The authors report a rare case of retroperitoneal ganglioneuroma discovered incidentally in a 47-year-old male during abdominal computed tomogaphy(CT) evaluation. The clinical features and findings of the complementary examinations, which included radiological assessment, abdomen CT and lumbar spine magnetic resonance image with contrast enhancement are presented, as well as the pathology findings. The tumor, 10x10x6cm in size, was well encapsulated and total removal was made. Histopathological diagnosis of retroperitoneal ganglioneuroma was confirmed.
Abdomen ; Diagnosis ; Ganglioneuroma* ; Humans ; Male ; Middle Aged ; Pathology ; Spine

Intradural lumbar disc herniation(ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament(PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely related to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is relatively good. We report on case of ILDH at L3/4 with differential diagnoses, and the possible pathogenic factors are discussed.
Diagnosis ; Diagnosis, Differential ; Neurologic Manifestations ; Pathology ; Prognosis ; Spine