Object Symptomatic herniated thoracic discs remain a surgical challenge and historically have been associated with significant complications. While neurological outcomes have improved with the abandonment of decompressive laminectomy, the attempt to minimize surgical complications and associated morbidities continues through less invasive approaches. Many of these techniques, such as thoracoscopy, have not been widely adopted due to technical difficulties. The current study was performed to examine the safety and early results of a minimally invasive lateral approach for symptomatic thoracic herniated intervertebral discs. Methods Sixty patients from 5 institutions were treated using a mini-open lateral approach for 75 symptomatic thoracic herniated discs with or without calcification. The mean age was 57.9 years (range 23–80 years), and 53.3% of the patients were male. Treatment levels ranged from T4–5 to T11–12, with 1–3 levels being treated (mean 1.3 levels). The most common levels treated were T11–12 ...

Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience

https://www.unilim.fr/campus-neurochirurgie/IMG/pdf/article%205.pdf

Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy

Pretreatment of Depression Before Cervical Spine Surgery Improves Patients' Perception of Postoperative Health Status: A Retrospective, Single Institutional Experience.

Central Sensitization Inventory as a Predictor of Worse Quality of Life Measures and Increased Length of Stay Following Spinal Fusion.

STUDY DESIGN A prospective study. OBJECTIVE The aim of this study was to elucidate the impact of axial pain following cervical laminoplasty on health-related quality of life (HRQOL). SUMMARY OF BACKGROUND DATA Axial neck pain is a frequently encountered complication after laminoplasty. However, limited information is available regarding the time-dependent changes in axial pain and the impact of this pain on clinical outcomes, including HRQOL. METHODS One hundred sixty-two consecutive patients with cervical myelopathy underwent double-door laminoplasty using hydroxyapatite spacers from 2008 to 2012. The outcome measures included the Japanese Orthopaedic Association score (JOA score), the EuroQol 5 Dimension Questionnaire (EQ-5D), and the Short Form-36 survey (SF-36). The intensity of axial pain was assessed using an 11-point numerical rating scale (NRS). These assessments were conducted preoperatively and at 6-month, 1-year, and 2-year follow-ups. Patient satisfaction with outcome was graded using a 7-point NRS at the 2-year follow-up. RESULT One hundred twenty-one patients completed the 2-year follow-up. The mean axial pain intensity decreased slightly over time; however, the decrease was not significant. The JOA score, EQ-5D score, and all SF-36 domains, excluding general health perceptions, improved significantly compared with baseline levels at the 6-month follow-up or later. Baseline axial pain intensity showed a significant negative correlation with baseline HRQOL only in the SF-36 bodily pain domain. In contrast, axial pain intensity showed significant negative correlations with all HRQOL measures at the 6-month follow-up. At the 2-year follow-up, patients with an axial pain intensity ≥3 showed significantly worse outcomes than did patients with a pain intensity <3 in the EQ-5D score, SF-36 score, and patient satisfaction grades, but not in the JOA score. CONCLUSION Axial neck pain has a significant negative impact on clinical outcomes, including a wide range of HRQOL measures and patient satisfaction with outcome, in patients undergoing conventional double-door laminoplasty. LEVEL OF EVIDENCE 3.

Impact of Axial Neck Pain on Quality of Life After Laminoplasty.

BACKGROUND CONTEXT: Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery Affective disorders, such as depression, are associated with worsened outcomes after lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery PURPOSE: To assess the predictive value of preoperative depression and the health state on 1-year quality of life (QOL) outcomes after PCF STUDY DESIGN: A retrospective cohort analysis PATIENT SAMPLE: Eighty-eight patients who underwent PCF for cervical spondylosis were reviewed OUTCOME MEASURES: Preoperative and 1-year postoperative health outcomes were assessed based on the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire-9 (PHQ-9), and the EuroQol five-dimensions (EQ-5D) questionnaire METHODS: Univariable and multivariable regression analyses were performed to assess for preoperative predictors of 1-year change in health status RESULTS: Compared with preoperative health states, the PCF cohort showed statistically significant improved PDQ (878 vs 736), PHQ-9 (77 vs 66), and EQ-5D (050 vs 060) scores at 1 year postoperatively Only 10/88 (11%) patients achieved or surpassed the minimum clinically important difference for the PHQ-9 (5) Multiple linear and logistic regression analyses showed that increasing PHQ-9 and EQ-5D preoperative scores were associated with reduced 1-year postoperative improvement in health status (EQ-5D index)

Clinical Study The impact of preoperative depression on quality of life outcomes after posterior cervical fusion

The thoracic spine is a structurally unique region that renders it uniquely suceptible to thoracic disc herniation. Surgical management strategies are complicated, in part, by the regional anatomical and biomechanical nuances. Surgical approaches include posterior, posterolateral, and anterior routes. Each isassociated with specific indications and contraindications. The biomechanical principles and safe anatomical trajectories must be considered in the surgical decision-making process. These issues are discussed in the pages that follow.

/pdf/biomechanics-of-thoracic-discectomy-kj1fhf13xo.pdf

Biomechanics of thoracic discectomy.

Tienda online donde Comprar Benzel's Spine Surgery. Techniques, Complication Avoidance And Management, 2 Vols. (Online And Print) 4th Ed. al precio 378,04 € de Edward C. Benzel | Michael P. Steinmetz, tienda de Libros de Medicina, Libros de Traumatologia y Ortopedia - Cirugia ortopedica

Comprar Benzel's Spine Surgery. Techniques, Complication Avoidance And Management, 2 Vols. (Online And Print) 4th Ed. | Edward C. Benzel | 9780323400305 | Elsevier España

BACKGROUND CONTEXT: The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. PURPOSE: To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. STUDY DESIGN/SETTING: Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. METHODS: Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. RESULTS: A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% vs. 47%; p5.0001) and preoperative radiculopathy (90% vs. 75%; p5.03) than their counterparts in the MS group. Patients in the MS

2013 Outstanding Paper Runner-up Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: a cohort-controlled analysis

Subsidence and Dynamic Cervical Spine Stabilization

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