A 35 years old female presented to us after falling from a height. She complained of a neck pain and a complete quadriplegia and was diagnosed as having spondyloptosis of the C6-C7. Skeletal traction was performed on her. CT scan showed fractures of the C5, C6, and C7 vertebral body. The patient underwent anterior approach partial corpectomy with anterior cervical locking plate and strut grafting from ipsilateral iliac crest. Intraoperatively it was found that the disc was completely ruptured and there was a dural tear and cerebrospinal fluid leak. Her postoperative period was complicated by cerebrospinal fluid collection and posterior instrumentation was not performed due to the poor general condition. She had no neural recovery at the last follow-up. Spondyloptosis is a severe and highly unstable injury with a three column ligamentous disruption and may be complicated, as in our case, with a dural tear. Management of these cases is fraught with complications, and prognosis for neural recovery is dismal.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery

Combined Modality Therapy ; Humans ; Lumbar Vertebrae ; pathology ; physiopathology ; surgery ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery ; therapy

Decompression, Surgical ; Humans ; Lumbar Vertebrae ; surgery ; Spinal Fusion ; Spondylolisthesis ; diagnosis ; physiopathology ; surgery

Since the introduction of MRI, the arachnoiditis could easily haute been diagnosed by confirming the abnormal distribution of the roots in the dural sac. But the arachnoiditis-like pattern of nerve root distribution in a degenerative disc disease has been regarded as a an incorrect diagnosis of arachnoiditis. The arachnoiditis has been one of the most serious complication in the failed back surgery syndrome. MR images of 32 patients with acute or chronic radicular pain syndrome were investigated by a radiologist and a orthopedc surgeon. 17 patients had lumbar disc herniation; 13 patients, pure spinal stenosis; 2 patients, spondylolisthesis. The discriminant analysis was used to calculate the cutting point of clumping for the abnormal nerve root distribution and to assess the relationship between the arachnoiditis-like pattern of nerve root distribution and other factors According to the result of calculation, the cutting point of clumping In spinal stenosis was 9mm and that in a disc herniation was 6mm. Central clumping of nerve roots in the durn is considered as a characteristic finding at the constricted level of the lumbar degenerative disease. However, the appearance is not a differentiating factor between the adhesive arachnoiditis and constriction in the lumbar degenerative disease. Clinically, the adhesive arachnoiditis should be suspected in the lumbar degenerative disease with the nerve root clumping at multiple level, not associated with remarkable constriction of spinal canal. In the disc herniation with their sagittal diameter over 6mm, the clumping seems to imply the possibility of association with adhesive arachnoiditis.
Adhesives ; Arachnoid ; Arachnoiditis ; Constriction ; Diagnosis ; Failed Back Surgery Syndrome ; Humans ; Magnetic Resonance Imaging ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: The two most common types of surgically treated lumbar spondylolisthesis in adults include the degenerative and isthmic types. The aim of this study was to compare the functional outcomes of surgical decompression and posterolateral instrumented fusion in patients with lumbar degenerative and isthmic spondylolisthesis. METHODS: In this retrospective study, we reviewed the clinical outcomes in surgically treated patients with single level, low grade lumbar degenerative, and isthmic spondylolisthesis (groups A and B, respectively) from August 2007 to April 2011. We tried to compare paired settings with similar initial conditions. Group A included 52 patients with a mean age of 49.2 +/- 6.1 years, and group B included 52 patients with a mean age of 47.3 +/- 7.4 years. Minimum follow-up was 24 months. The surgical procedure comprised neural decompression and posterolateral instrumented fusion. Pain and disability were assessed by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. The Wilcoxon and Mann-Whitney U-tests were used to compare indices. RESULTS: The most common sites for degenerative and isthmic spondylolisthesis were at the L4-L5 (88.5%) and L5-S1 (84.6%) levels, respectively. Surgery in both groups significantly improved VAS and ODI scores. The efficacy of surgery based on subjective satisfaction rate and pain and disability improvement was similar in the degenerative and isthmic groups. Notable complications were also comparable in both groups. CONCLUSIONS: Neural decompression and posterolateral instrumented fusion significantly improved pain and disability in patients with degenerative and isthmic spondylolisthesis. The efficacy of surgery for overall subjective satisfaction rate and pain and disability improvement was similar in both groups.
Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae/surgery ; Male ; Middle Aged ; Recovery of Function ; Spinal Fusion ; Spondylolisthesis/diagnosis/*surgery ; Treatment Outcome

Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis.
Aged ; Aged, 80 and over ; Constriction, Pathologic ; Decompression, Surgical/*methods ; Female ; Humans ; *Lumbar Vertebrae ; Male ; Patients ; Postoperative Complications/diagnosis ; Spinal Stenosis/*surgery ; Spondylolisthesis/*surgery ; Surgical Instruments ; Treatment Outcome

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control

BACKGROUND: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes. METHODS: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors. RESULTS: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). CONCLUSIONS: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.
Aged ; Female ; Humans ; Lumbar Vertebrae/surgery ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Scoliosis/complications/surgery ; Spinal Fusion/methods ; Spinal Stenosis/complications/diagnosis/*surgery ; Spondylolisthesis/complications/surgery ; Treatment Outcome