11/31. Anterior cervical arthrodesis using DOC dynamic stabilization implant for improvement in sagittal angulation and controlled settling.OBJECT: Placing instrumentation in the anterior cervical spine is a common procedure. The bi- and unicortical systems currently available, however, have distinct advantages and disadvantages. The author reports a prospective series in which a new dynamized anterior cervical fixation system was evaluated. methods: Thirty-seven patients underwent anterior cervical discectomy and fusion in which the DOC ventral cervical stabilization system was used for indications including cervical spondylotic radiculopathy, disc herniation, trauma, and myelopathy. patients underwent anterior cervical discectomy and interbody fusion and/or corpectomy. Preoperative and postoperative clinical data included assessment of spinal cord and nerve root deficit, function, neck pain, and arm pain. Preoperative and postoperative radiographic data included sagittal angle, translation, and settling of the graft. Fusion status was determined by the presence of trabecular bridging bone on plain anteroposterior and lateral cervical radiographs. At a mean follow-up time of 1.3 years, postoperative neck or arm pain was resolved in 52% of the patients, restriction on function was mild or absent in 88%, and fusion was successful in 80% of patients and 88% of the treated levels. There was one implant-related complication, one significant dysphagia complication, and a 10.8% donor graft site complication rate. CONCLUSIONS: The use of this system led to a high percentage of pain relief and radiographic fusion. The sagittal angle was controlled while allowing for graft settling. There were no implant failures.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
12/31. Artificial disc insertion following anterior cervical discectomy.OBJECTIVE AND IMPORTANCE: Fusion following anterior cervical discectomy has been implicated in the acceleration of degenerative changes in the adjacent spinal segments. Discectomy followed by implantation of an artificial cervical disc maintains the functionality of the spinal unit, while still providing excellent symptomatic relief. We describe our preliminary experience with implantation of the Bryan Cervical Disc System in two cases of single-level cervical disc herniation. CLINICAL PRESENTATION: Two male patients presented with a left C6 radiculopathy, without evidence of myelopathy. magnetic resonance imaging revealed a disc herniation at C5-6 in both cases. Pre-operative flexion and extension radiographs demonstrated preserved motion at the involved levels. INTERVENTION/TECHNIQUE: Following a standard anterior cervical decompression, precision drilling of the vertebral endplates was carried out using a drill attached to a bed-mounted, gravitationally-referenced retraction frame. An artificial cervical disc, composed of a polyurethane nucleus with titanium endplates, was fitted between the contoured endplates without fixation to the vertebral bodies. No complications were experienced during the insertion of the prosthesis, or in the postoperative course. Both patients experienced immediate postoperative resolution of their radicular pain and were discharged from hospital the following day. At nine months following surgery, both patients continue to have complete relief of radicular symptoms. Postoperative radiographs at six months following surgery confirm accurate placement of the prosthesis and preserved mobility of the functional spinal unit. CONCLUSION: Insertion of the Bryan artificial cervical disc prosthesis following anterior cervical discectomy is a relatively straightforward procedure, which appears to be safe and provides good clinical results, without requiring additional surgical time. Long-term follow-up is required to assess its safety, efficacy, and ability to prevent adjacent segment degeneration.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
13/31. Upper thoracic spinal cord herniation after traumatic nerve root avulsion. Case report and review of the literature.Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and brown-sequard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
14/31. Anterior cervical fusion using porous hydroxyapatite ceramics for cervical disc herniation. a two-year follow-up.BACKGROUND CONTEXT: The Smith-Robinson Method (SR), which employs autogenous bone, is the current standard for anterior cervical fusion (AF) surgery. However, autogenous bone has graft-related complications and morbidity, and harvesting it increases trauma and risk to the patient. The use of hydroxyapatite ceramic (HAP) inserts may provide a superior alternative. PURPOSE: To determine the efficacy of using HAP in AF. STUDY DESIGN/SETTING: A retrospective study of patients who had AF surgery with wide decompression and porous HAP inserts used to treat cervical disc herniation (CHD). PATIENT SAMPLE: We evaluated 36 patients who had single-level AF using HAP for CHD, without internal fixations, clinically and radiographically with a minimum follow-up of 2 years. There were 25 men and 11 women, with an average age of 49 years (age range, 24-78 years). Preoperative diagnosis included 25 cases with myelopathy and 11 cases with radiculopathy. OUTCOME MEASURES: We established four grades to classify the degree of bony fusion between the HAP and vertebra, based on any motion at the fused segment, any radiolucent zones (RZ) between vertebral bodies and the grafted HAP, and anterior or posterior bone formations on grafted HAPs. We evaluated the severity of myelopathy by applying the japan Orthopaedic association (JOA) scoring system. We evaluated the surgical outcome of the myelopathy patients using the Hirabayashi recovery rating, and for the radiculopathy patients, we used the Herkowitz criteria. methods: We retrospectively reviewed the radiographic and clinical records of all 36 patients from surgery up to periods ranging from 2 to 7 years after surgery, with the average period of follow-up being 4.5 years. We systematically classified the degree of bony fusion into four grades ranging from Grade 1 nonunion to Grade 4 complete union. RESULTS: None of the subjects showed Grades 1 and 2 fusion. Eleven percent of the cases showed Grade 3 and 89% showed Grade 4. Loss of height of the fused segment was observed in 29 cases with an average of 1.6 mm. A decrease of lordotic angle of the fused segment was observed in six cases with an average of 2.3 degrees. Four cases revealed cracked HAP inserts but achieved Grade 4 bone fusion. There was no evidence of collapse or displacement of HAPs. The results of the 11 radiculopathy patients were excellent in 10 cases and good in the remaining case. The recovery rate of the 25 myelopathy patients was 73.0%. CONCLUSIONS: Our method of anterior cervical fusion surgery using porous HAP inserted into resected end plates, combined with a wide decompression procedure, had clinical and radiographic results so satisfactory that we conclude that it can effectively replace the use of autogenous bone for treating cervical disc herniation.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
15/31. Far-lateral disk herniation: case report, review of the literature, and a description of nonsurgical management.OBJECTIVE: To review the history and examination of a far-lateral lumbar intervertebral disk herniation (FLLIDH), as well as the treatment and outcomes of a nonsurgical approach. CLINICAL FEATURES: A 60-year-old healthy male subject had a 3-week history of right buttock and calf pain. He initially had a left lateral list and asymmetrical pelvic landmarks. Range of motion (ROM) of the lumbar spine revealed full and pain-free lumbar flexion, right-sided pain with lumbar extension and left side bending, and painful and restricted left side bending. neurologic examination was unremarkable. INTERVENTION AND OUTCOME: The patient was treated with a lumbar epidural and nerve root injection, as well as manipulation. Physical therapy consisted of deweighting treadmill, autotraction, and strengthening exercises. Outcomes were measured by using the Modified Oswestry Questionnaire, as well as a numerical pain rating scale. His initial Oswestry was 73%, pain 9/10 at presentation. Upon discharge, the Oswestry was 0% and pain was rated as 0/10. CONCLUSION: A significant decrease was noted in both the Oswestry Questionnaire, as well as the pain rate. The patient returned to running on alternate days for a minimum of 30 minutes, which was his primary goal. This case demonstrated a positive outcome using a multidisciplinary approach in a patient diagnosed with a FLLIDH. He obtained his goals and his function was fully restored.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
16/31. S1 radiculopathy due to adenocarcinoma: a case study.What may initially appear to be a classic presentation of a common condition--in this case sciatic radiculopathy from presumed disc herniation--can sometimes reflect a more ominous process. This article discusses the presentation, diagnosis, and management of a patient initially referred for neurosurgical consultation for S1 radiculopathy suspected to be due to a work-related injury. Final diagnosis was metastatic adenocarcinoma of the rectum.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
17/31. sciatica, disk herniation, and neuroborreliosis. A report of four cases.We report four cases of sciatica in patients with same-level disk herniation confirmed by computed tomography and a final diagnosis of acute radiculitis caused by borrelia burgdorferi, with a favorable response to ceftriaxone therapy. The neurological manifestations of lyme disease are protean, and a potential contribution of concomitant disk disease to sciatica can lead to diagnostic wanderings. Disk lesions and infectious conditions that can cause sciatica are discussed. Whether a favorable response to antibiotic therapy should be taken as proof of B. burgdorferi radiculitis deserves discussion. In practice, in a patient with clinical manifestations suggesting disk-related nerve root pain and residing or having traveled to an endemic area, B. burgdorferi infection should be looked for, as both etiologies can coexist.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
18/31. Concomitant sacroiliac joint pain in patients with lumbar disc herniation: case series.Recent studies have shown that not all lumbar disc herniations are symptomatic and that when followed longitudinally, these patients develop back pain independent of the previous imaging study. This is a case report of two patients with radicular symptoms and lumbar disc herniations that underwent diagnostic injections to locate their pain generator. Both patients failed to respond to transforaminal epidural steroid injections. Transforaminal injections can be diagnostically sensitive for radicular pain but not specific. This is a direct result of the spread of medication to other levels in the epidural space, thus affecting multiple levels of innervation. Follow-up with two sacroiliac injections gave significant relief of their pain. They were both treated conservatively for sacroiliac joint pain and did well. One remained pain free after several months and the second remained with minimal pain until she presented again in her 3rd month of pregnancy with return of her pain. The differential diagnosis of lumbar radicular pain is discussed as well as the authors' experience in using diagnostic injections.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
19/31. Propriospinal myoclonus due to cervical disc herniation. Case report.Propriospinal myoclonus is a rare form of spinal myoclonus. In most cases the cause has remained unclear. Secondary propriospinal myoclonus has been described secondary to various disorders including trauma, tumor, and infection. Thus far, propriospinal myoclonus caused by cervical disc herniation has not been reported. In the present report, the authors describe the case of a 53-year-old man who presented with radicular symptoms of the right C-6 nerve root and myoclonic twitches predominantly affecting the abdominal muscles but spreading to adjacent muscles. The spread was triggered and enforced by certain movements. magnetic resonance imaging studies revealed a C-6 nerve root compression at the C5-6 level on the right side but no cervical myelopathy. electromyography studies confirmed the diagnosis of propriospinal myoclonus. After discectomy and cage-augmented fusion via an anterior approach, the myoclonic movement disorder gradually subsided. To the authors' knowledge, this is the first report on successful treatment of propriospinal myoclonus by spinal disc surgery.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
20/31. Thoracic herniation after lumbar spine fusion.We report on a 65-year-old male patient with rapid onset of incomplete paraparesis, based on a massive thoracic herniation following adjacent instability of the thoracolumbar spine after lumbar fusions with transpedicular instrumentation.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
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