Laminectomy Research Articles

A case report of Spontaneous Spinal Epidural Hematoma in Elderly Patient with Surgical Decompression

Spontaneous spinal epidural hematoma (SSEH), uncommon disorder with potentially devastating consequences as high morbidity. Incidence around 0.1 in 100,000 per/year, male- female ratio is approximately 1.4:1, most cases in 4th-5th decades. The etiology was associated with lumbar puncture and myelography, arteriovenous malformations, bleeding disorders, pregnancy, spinal manipulation. Anticoagulation is also a risk factor for spontaneous spinal epidural hematomas, warfarin is the most common related with SSEH. SSEH present clinically as a cord compression syndrome, acute onset pain and neurological deficit such as progressive motor or sensory symptoms, sphincter dysfunction, ultimately leads to complete/incomplete motor deficit caused by spinal cord/nerve root compression or cauda equina. The symptoms depending on the location of the hematoma. The worst prognostic factors are thoracic location, anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, rapid progression. Magnetic resonance imaging (MRI) is the gold standard technique to diagnose SSEH. Once the diagnosis is established with clinical and imaging results, early surgical intervention should be considered. Currently, appropriate management is emergence decompression laminectomy and hematoma evacuation. We present the case of 87-year-old female, on warfarin for atrial fibrillation. Without recent trauma events. Presented sudden thoracic and lumbar pain, paresthesias with irradiation to legs. Progression with sudden paraplegic and anesthesia in lower extremities. Thoracolumbar MRI revealed a posterior SSEH extended from T9-T12. Was released a laminectomy and SSEH aspiration within 6 hours from the symptom’s onset. The patient was discharged one week after the surgery, symptoms improved during the follow-up.

Decompressive laminectomy with vertebral stabilization allows neurologic improvement of most Pekingese dogs with thoracolumbar vertebral instability.

To describe the diagnostic findings, surgical techniques, and outcomes of thoracolumbar vertebral instability associated with or without articular process (AP) anomalies in Pekingese dogs. 11 client-owned Pekingese dogs. Medical records (2007 to 2022) were reviewed. Inclusion criteria were Pekingese dogs with thoracolumbar vertebral instability that underwent decompressive laminectomy and vertebral stabilization. Dynamic myelographic study and/or intraoperative spinal manipulation were used to diagnose vertebral instability. Data on preoperative and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes were retrieved. The dogs presented with paraparesis (n = 9) or paraplegia (2). Five dogs had caudal AP anomalies. Dynamic myelographic study demonstrated single (n = 7) or multiple (4) dynamic compressions with poststress spinal cord height reduction (median, 12.5%; IQR, 6.8% to 21.2%). Of the 17 dynamic compression lesions, 5 lesions were at the disc spaces with caudal AP abnormalities. All dogs had vertebral instability confirmed by intraoperative spinal manipulation and underwent hemilaminectomy and unilateral vertebral stabilization. One dog had adjacent segment vertebral instability and underwent vertebral stabilization 3 months after the initial operation. All but 1 dog showed successful outcomes at the last follow-up (median, 16 months; IQR, 3 to 32 months). Vertebral instability associated with or without AP abnormalities is a potential cause of thoracolumbar spinal cord injury in Pekingese dogs. Dynamic myelographic studies and/or intraoperative spinal manipulation demonstrated vertebral instability. Spinal cord decompression and vertebral stabilization are effective, resulting in neurologic improvements in most dogs.

Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial.

Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery ( n = 3), spinal tumor ( n = 3), and spinal infection ( n = 5). A total of 31 patients were randomly divided into the UBS group ( n =15) and the conventional group ( n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.

Pre-operative magnetic resonance imaging as a predictor of success in lumbar disc herniation patients undergoing laminectomy

Introduction. Lumbar disc herniation is a condition in which annulus fibrosus in the lumbar area is herniated with numerous etiologies, such as degenerative. One of the mainstay treatment for lumbar disc herniation is decompressive laminectomy. Magnetic Resonance Imaging (MRI) with the diagnostic accuracy of 97% also has an excellent resolution for soft tissue. The aim of this study is whether pre-operative MRI may be a predictor of successful clinical outcome in lumbar disc herniation patients undergoing laminectomy surgery. Methods. In this cross-sectional study, we consecutively collected all patients in Radiology Department “Prof. Dr. IGNG Ngoerah” Hospital, Denpasar Bali between January 2021 to December 2022. We enrolled patients with older than 18 years old who had undergone pre-operative lumbosacral MRI and had laminectomy surgery within the sampling time period. The following variables were recorded from each patient: age, gender, Body mass index (BMI), history of diabetes mellitus, hypertension, number of herniated discs, herniation grade, spinal canal stenosis grade, neural foramen stenosis grade, lateral recess stenosis grade, annular tear, disc degeneration, facet disc degeneration, thickening of ligamentum flavum, modic changes, cerebrospinal liquor obstruction, and clinical outcome. Outcomes. We collected 30 patients who underwent laminectomy surgery and had their pre-operative MRI. Patients’ mean age ± SD was 57.7±10.9 years old with 20 male (66.7%) and 10 female (33.3%). There was no significant association between gender, hypertension, diabetes mellitus, body mass index, number of disc herniation, spinal canal stenosis, lateral recess stenosis, neural foramen stenosis, disc degeneration, facet joint degeneration, ligamentum flavum hypertrophy, Modic changes and cerebrospinal liquor obstruction with clinical outcome post laminectomy patients. Conclusion. Pre-operative MRI can reliably diagnose lumbar disc herniation but are not a predictive tool in assessing the clinical outcome of post-laminectomy patients. Laminectomy has an excellent management value for lumbar disc herniation patients especially in reducing the pain, and for them to have better quality of life.

Landmine Injury Resulting inComminuted Lumbar Facet Fracture as a Cause ofLumbar Stenosis andSpondylolisthesis.

Lumbar facet fractures are rarely reported and have been linked to sports and spine surgery. We describe the case of a 77-year-old patient who sustained an injury from multiple landmine blasts during the Vietnam War. He had low back pain since that time, which was initially managed conservatively. However, the pain progressed over decades to severe neurogenic claudication that greatly restricted his quality of life. Neuroimaging revealed the presence of bone fragments impinging on the spinal canal at the L5/6 level (transitional anatomy) that resulted from a comminuted fracture of the lumbar facet at the inferior articular process. We performed an L5/6 decompressive laminectomy, with removal of these fragments, and posterior instrumented fusion, with substantial improvement in symptoms. This case illustrates a unique mechanism of lumbar facet fracture and the biomechanic origination, natural history, and optimal treatment of this entity. We expand on the spectrum of lumbosacral injuries associated with the combat blast injury that have only increased in prevalence in recent conflicts.

A Laminectomy Decompression in Radiculopathy Vertebrae L3-L4, L4-L5: A Case Report

Abstract. Introduction: Spinal tumors are uncommon lesions and affect only a minority of the population. Spinal metastases comprising approximately 97% of masses encountered with spinal imaging and is the most common site of metastasis from breast cancer. The sign and symptom for metastatic spinal tumors is varied from back pain, motoric and sensoric dysfunction and in advanced disease, spinal cord compression.Case Report: In this case, we report a 39-year-old female patient with complaints of weakness in the lower limb with history of breast cancer. The patient underwent a contrast lumbosacral MRI examination and found the patient has metastatic spine tumors. The patient was then planned to undergo laminectomy decompression, tumor resection, and posterior stabilization procedures. Conclusion: Spinal tumors is a condition that can arise within spinal cord itself or from the adjacent structures. It affects only a minority of the population. The hallmark symptom for spinal metastases is back pain. Surgical techniques such as open decompression and stabilization are used from the condition of the patient who has a neurodeficit and compression from radiological examination with good prognosis. Keywords: Breast cancer, Metastatic spinal tumors, Neurosurgery, Weakness

Perspective: Transthoracic, posterolateral, or transpedicular approaches to thoracic disks, not laminectomy.

Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for decades due to the much lower rate of acceptable outcomes (i.e., 57% for decompressive laminectomy vs. over 80% for the posterolateral, lateral, and transthoracic procedures), and a higher risk of neurological morbidity/paralysis. Patients with TDH averaged 48-56.3 years of age, and presented with pain (76%), myelopathy (61%-99%), radiculopathy (30%-33%), and/or sphincter loss (16.7%-24%). Those with anterior/anterolateral TDH (30-74%) were usually myelopathic while those with more lateral disease (50-70%) exhibited radiculopathy. Magnetic resonance (MR) studies best defined soft-tissue/disk/cord pathology, CAT scan (CT)/Myelo-CT studies identified attendant discal calcification (i.e. fully calcified 38.9% -65% vs. partial calcification 27.8%), while both exams documented giant TDH filling > 30 to 40% of the canal (i.e., in 43% to 77% of cases). Surgical options for anterior/anterolateral TDH largely included transthoracic or posterolateral approaches (i.e. costotransversectomy, lateral extracavitary procedures) with the occasional use of transfacet/transpedicular procedures mostly applied to lateral disks. Notably, patients undergoing transthoracic, lateral extracavitary/costotransversectomy/ transpedicular approaches may additionally warrant fusions. Good/excellent outcomes were quoted in from 45.5% to 87% of different series, with early postoperative adverse events reported in from 14 to 14.6% of patients. Anterior/anterolateral TDH are largely addressed with transthoracic or posterolateral procedures (i.e. costotransversectomy/extracavitary), with a subset also utilizing transfacet/transpedicular approaches typically adopted for lateral TDH. Laminectomy is essentially no longer considered a viable option for treating TDH.

Minimally Invasive Bilateral Decompressive Lumbar Laminectomy with Unilateral Approach Among Obese versus Nonobese Patients

Decompressive lumbar laminectomy (DLL) is a common procedure for lumbar stenosis. A unilateral approach, unlike the traditional open approach, spares the posterior elements to mitigate the risk of iatrogenic instability associated with a DLL. Various minimally invasive techniques have been described but little attention has been aimed toward this specific microsurgical approach, particularly regarding obese patients. We aimed to compare operative details, perioperative outcomes, and complication profiles between obese and nonobese patients. One hundred and ninety-four patients who underwent bilateral laminectomy with a unilateral approach by the study surgeon from July 2013 to June 2018 were included. Of these patients, 105 were classified as obese, with body mass index (BMI) ≥30.0 kg/m2, and 89 were nonobese, with BMI <30.0 kg/m2. The obese and nonobese groups were compared; operative time, blood loss, and complications were assessed. Operative time was nonsignificantly increased in the obese group (177 vs. 166 minutes; P= 0.21) and estimated blood loss was nonsignificantly lower (91 mL vs. 97 mL; P= 1.00) in the obese group. Durotomy rates (3 [2.9%] obese vs. 2 [2.2%] nonobese; P= 0.789) and postoperative wound drainage rates (4 [3.8%] obese vs. 2 [3.8%] nonobese; P= 0.92) did not significantly differ between the 2 groups. Length of stay was significantly longer in the obese group (1.5 vs. 1.0 days; P= 0.0005). Compared with the nonobese group, the obese group had significantly longer length of hospitalization, as well as nonsignificantly increased length of operation and decreased blood loss. The 2 groups had similar perioperative complication rates.

Neuroendoscopy-Assisted Minimal Invasive Management of Chiari 1 Malformation.

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia. Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared. Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80-150 minutes). The average blood loss was 40 mL (20-110 mL). Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.

Severe Symptomatic Epidural Hematoma Following Percutaneous Endoscopic Unilateral Laminectomy for Bilateral Decompression (Endo-ULBD)-Series Report and Management Strategies.

Severe symptomatic epidural hematoma (SSEH) is one of the most severe complications following percutaneous endoscopic unilateral laminectomy for bilateral decompression (Endo-ULBD). Considering that this technique has been performed for a short time, no detailed reports have been recently published. Thus, it is critical to gain a better understanding of SSEH occurring in its postoperative period with regard to its incidence, possible causes, outcome, etc., in order to identify relevant management strategies. Patients with spinal stenosis who had undergone Endo-ULBD in our department from May 2019 to May 2022 were retrospectively analyzed. Of which, patients with postoperative epidural hematoma were followed-up. The preoperative and postoperative physical conditions of each patient were recorded, and the information related to hematoma removal surgery was recorded in detail. Clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI), and the results were classified into "excellent," "good," "fair," or "poor" based on the modified MacNab criteria. The incidence of hematoma with different factors was calculated, and a bar graph was used to compare the difference of the indexes related to hematoma removal between cases, and a line graph was used to reflect the trend of the outcome of each patient within 6 months to evaluate the effect of the treatment. A total of 461 patients with spinal stenosis who underwent Endo-ULBD were enrolled in the study. SSEH occurred in four cases, with an incidence rate of 0.87% (4/461). All these four patients underwent decompression of multiple segments, and three of them had a history of hypertension comorbid with diabetes. Notably, one patient had a past history of hypertension and coronary artery disease and was on postoperative low molecular heparin due to lower extremity venous thrombosis. According to the conditions of the four patients, three types of treatment were used. And with timely treatment, all patients recovered well. Despite being a minimally invasive technique, postoperative epidural hematoma remains a severe complication of Endo-ULBD. Therefore, during percutaneous endoscopic surgery, it is essential to enhance the comprehensive perioperative management of patients with Endo-ULBD. Signs related to postoperative hematoma must be recognized and promptly managed. If necessary, satisfactory results can be achieved by using percutaneous endoscopy along the original surgical channel to remove the hematoma.

Perioperative Intravenous Nefopam on Pain Management and Ambulation after Open Spine Surgery: A Randomized Double-Blind Controlled Study.

This was a randomized double-blind controlled study. This study was designed to evaluate the effects of intravenous nefopam regarding its ability to reduce morphine consumption and postoperative pain and improve recovery in patients undergoing open spine surgery. Multimodal analgesia, including nonopioid medications, is essential for pain management in spine surgery. Evidence regarding the use of intravenous nefopam in open spine surgery as part of enhanced recovery after surgery is lacking. In this study, 100 patients undergoing lumbar decompressive laminectomy with fusion were randomized into two groups. The nefopam group received 20-mg intravenous nefopam diluted in 100-mL normal saline intraoperatively, followed by 80-mg nefopam diluted in 500-mL normal saline, administered as a continuous infusion postoperatively for 24 hours. The control group received an identical volume of normal saline. Postoperative pain was managed using intravenous morphine via patient-controlled analgesia. Morphine consumption in the first 24 hours was recorded as the primary outcome. Secondary outcomes, including postoperative pain score, postoperative function, and length of hospital stay (LOS), were assessed. No statistically significant differences in the total morphine consumption and postoperative pain score in the first 24 hours postoperatively between the two groups. At the post-anesthesia care unit (PACU), the nefopam group demonstrated lower pain scores while at rest (p =0.03) and upon movement (p =0.02) than the normal saline group. However, the severity of postoperative pain between the two groups was similar from postoperative day 1 to day 3. LOS was significantly shorter in the nefopam group than in the control group (p <0.01). The time to first sitting and walking and PACU discharge between the two groups were comparable. Perioperative intravenous nefopam demonstrated significant pain reduction during the early postoperative period and shortened LOS. Nefopam is considered safe and effective as a part of multimodal analgesia in open spine surgery.

Rare case of vertebral hemangioma causing spinal compression - diagnosis and treatment: Space Occupying Lesion (SOL) study

Background. This case report highlights the importance of accurate diagnosis and treatment for intramedullary spinal cord hemangioma, which is a rare condition that can present with common symptoms of various spinal cord pathologies. The report recommends decompression laminectomy as the appropriate intervention for this condition. This report adds to the existing clinical literature on intramedullary spinal cord hemangioma and can assist clinicians in the diagnosis and treatment of similar cases. Case report. The patient is a 30-year-old female who complained of left leg heaviness, cramps, numbness, and urinary incontinence. MRI revealed a suspected intradural intramedullary lesion, as high as VTh5, suspected to be ependymoma or astrocytoma. The patient underwent decompressive laminectomy on thoracalis vertebra 5-7 and spinal cord mass with hemorrhage and calcification components was observed on post-operative Spinal CT Angiography. The mass was found to have a feeder artery from spinal branches of the left right a. intercostalis at T5 level and spinal branches of the left a. intercostalis at T6 level. Thoracolumbar spondylosis was also observed. Conclusion. The clinical impact of vertebral hemangioma lies in its potential to cause neurological deficits due to spinal cord or nerve root compression. Early diagnosis and treatment through imaging modalities such as MRI and surgical intervention, such as laminectomy, can alleviate symptoms and prevent disability or mortality. However, careful consideration of the patient’s clinical history, imaging findings, and neurological status is necessary for accurate diagnosis and appropriate management.

Penetrating thoracic spine injury causing haemothorax

Background. Penetrating spine injuries can cause catastrophic complications to the patient, and it demands immense medical care to minimize the insult. Mainly, it occurs in the military field; however, it has become more prevalent among civilians due to gun availability. The thoracic spine is the most affected part, followed by the cervical and lumbar spine. Case report. A 15-year-old teenage boy had a penetrating injury to the thoracic (T10) vertebrae due to a missile bullet that resulted in bilateral lower limb weakness and required him to undergo decompressive laminectomy. During surgery, a missed hemothorax was discovered incidentally. Conclusion. To the best of the author's knowledge, this case of penetrating thoracic spine injury due to a missile bullet associated with missed hemothorax has not been previously reported. This paper discusses the importance of early detection and treatment of injuries associated with penetrating spine trauma to improve patient survival and disability.

ID: 212778 Minimally Invasive Interspinous Process Decompression for Elderly Patient With L1-L2 Lumbar Stenosis

Lumbar spinal stenosis (LSS) is the progressive narrowing of the spinal canal. In the USA, the prevalence of LSS in those older than 60 is 47% making it one of the most common causes of lower back pain (1). Diagnosis is multifaceted and based on history, physical exam, and imaging studies. LSS with neurogenic claudication characteristically presents as pain relieved by sitting and worse with standing (2). The initial management of LSS consists of physiotherapy and anti-inflammatory medications followed by epidural steroid injections. When conservative treatment fails, the most common surgical management is decompressive laminectomy with or without fusion (3). Open spinal surgery, however, is not without risks given that the majority of LSS patients are elderly and have multiple comorbidities. An effective procedure in relieving symptomatic LSS is minimally invasive interspinous process decompression which entails an interspinous spacer that is implanted under local anesthesia (4).

Short Term Clinical Outcomes in Spine Surgeries. A Descriptive Cross Sectional Study in a Tertiary Care Hospital

Objective: To find out the short-term post operative outcomes faced by patients undergoing various spine procedures. Study Setting: Neurosurgery department Khyber Teaching Hospital Peshawar Khyber Pakhtunkhwa. Study Duration: January 2022 to January 2023 Study Design: Cross-sectional study (descriptive). Material and Methods: After taking approval from the hospitals ethical and research committee a single center review of the medical records of all patients who underwent common surgical procedures of the spine were collected and patients followed for short term post -operative outcomes. Data was analyzed by using the statistical software SPSS version 23.0 and the results were presented in the form of tables and charts. Results: Out of 360 patients included in the study, 206 (57.2%) were males and 154 (42.8%) were females with a mean age of 41.3 ± 13.4. The highest percentage of patients presented with a PIVD at L4-L5 (n=176, 48.9%). It turns out that aged patients had more VRS scores compared to young candidates after surgery (p-value= 0.05) and patients who underwent only decompressive laminectomies had noticeable reduction frequency of discitis (p-value= 0.40) and a remarkable improvement in the VRS score after surgery (p value=&lt;0.01) as compared to other procedures. Conclusion: Even though laminectomy, being the procedure of choice in so many cases, significantly treats neurogenic claudication, still unresolved back pain is the most common complaint made by patients in the post operative period. However, despite complications, patient satisfaction rates have improved over the period of time. Keywords: Post-operative complications, laminectomy, discectomy, neurosurgery

Uniportal full endoscopic spinous process-preserving laminectomy for bilateral decompression in cervical stenotic myelopathy: patient series.

Endoscopic decompression for cervical stenotic myelopathy has several advantages over conventional open surgery. However, sometimes performing bilateral decompression, especially contralateral decompression, can be dangerous. The cervical spine has specific characteristics, including a shallower lamina angle and thinner lamina than the lumbar or thoracic lamina. These characteristics may cause cord compression when instruments approach the contralateral side of the lamina. This article introduces a novel surgical technique that can overcome the specificities of the cervical spine and discusses the efficacy and safety of uniportal full endoscopy for cervical decompression. Fourteen patients underwent uniportal full endoscopic spinous process-preserving laminectomy (ESP-L) for bilateral decompression of multilevel cervical stenotic myelopathy. The mean follow-up period was 13.44 months (range: 4-17 months). The preoperative and postoperative cervical spine angle and cervical range of motion did not differ significantly. The Japanese Orthopaedic Association score significantly improved postoperatively. The numeric rating scale scores significantly improved postoperatively. The mean duration of postoperative hospitalization was 2.3 days. ESP-L is a new, safe, effective, and noninvasive technique that can achieve complete decompression of multilevel cervical stenotic myelopathy.

Emergency Posterior Decompression for Metastatic Spine Tumors in Octogenarians: Clinical Course and Prognostic Factors for Functional Outcomes

This study aimed to describe the clinical outcome of metastatic epidural spinal cord compression in octogenarians with an acute onset of neurological illness who undergo laminectomy, further assess morbidity and mortality rates, and determine potential risk factors for a nonambulatory outcome. This retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Thirty-four patients aged 80 years and older who posterior decompression via laminectomy were enrolled in the present study. The mean Charlson Comorbidity Index was >6 (9.2 ± 2.1). The thoracic spine was the most common site of metastasis. A potentially unstable spine, determined using the Spinal Instability Neoplastic Score, was identified in 79.4% of the cases. Preoperatively, the neurological condition and functional status exhibited a notable decline (mean Motor Score of the American Spinal Injury Association grading system, 78.2 ± 16.4; mean Karnofsky Performance Index, 47.8 ± 19.5). The Motor Score of the American Spinal Injury Association grading system and Karnofsky Performance Index scores improved significantly after surgery. Motor weakness and comorbidities were unique risk factors for the loss of ambulation. Emergent decompressive laminectomy in patients with acute onset of neurological decline and potentially unstable spines improved functional outcome at discharge. Age should not be a determinant of whether to perform surgery; surgery should be performed in older patients when indicated.

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Currently, there are no reports on the specific classification of cervical spine trauma (CST) in ankylosing spondylitis (AS) based on the trauma mechanism. In this study, we aimed to describe a novel classification of CST in AS with more details, and put forward the corresponding surgical outcomes related to different types, hoping to provide a practical reference for clinical decision-making and academic communication. From January 2008 to December 2021, AS patients who experienced CST were retrospectively reviewed and included. Clinical data including gender, age, reason of trauma, time interval between AS diagnosis and trauma were collected. The American Spinal Injury Association (ASIA) grade system was used to describe patients' neurological status. Based on the combination of surgical experience and follow-up observation, the lower cervical spine trauma in AS patients was divided into three main types, namely single level fracture-dislocation (type 1), spinal cord injury without fracture-dislocation (type 2), and Andersson lesion (type 3). Furthermore, we performed detailed subtypes according to whether cervical spine was completely fused and the location of injury. Meanwhile, according to different approaches, surgical methods mainly included Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), Posterior Expansive Open-door Cervical Laminoplasty (PEOLP), Posterior Cervical Laminectomy Decompression and Fusion (PCLDF), and their combination. Postoperative general and surgery-related complications were also recorded. A total of 102 patients were enrolled, including 91 males and 11 females, with an average age of 51.9 years. Their average interval time between AS diagnosis and injury was 27.8 years. Patients with high-energy and low-energy trauma were 54 and 48 respectively. There were 79 patients suffering spinal cord nerve impairment after trauma. With regard to the distribution of different types, the number of patients in type 1, type 2, and type 3 were 86, 14, and two, respectively. For different types, PCLDF was the most commonly used surgical method, accounting for 55.9%, while ACCF was only applied for one time. In type 1, the frequencies of ACDF, ACCF, PCLDF, and ACDF+PCLDF were 10.5%, 1.2%, 55.8%, and 32.5%. In type 2, the frequencies of ACDF, PCLDF, ACDF+PCLDF, and PEOLP were 7.1%, 50.0%, 7.1%, 35.8%. Postoperatively, 21 patients achieved neurological function improvement. The incidences of general and surgery-related complications were 19.6% and 5.9%, respectively. All patients achieved bone fusion and durable decompression at the last follow-up. Our novel classification could enrich the scope of CST in AS patients and provide valuable references to the corresponding clinical management. Besides, there are strict indications of different surgical methods, factors like patient's physical condition, trauma type, surgical purpose, and expected efficacy were all required to consider before making a clinical decision.

Ultrasonic bone curette in thoracic spinal decompression: a comprehensive systematic review and meta-analysis.

The aim of this study was to compare the efficacy and safety of ultrasonic bone curette (UBC) and conventional surgical instruments in thoracic laminectomy decompression (TLD) for the treatment of thoracic spinal stenosis (TSS) by meta-analysis. Two authors independently searched Medline via PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, and China National Knowledge Infrastructure for the period from the establishment of the database until January 2023 to identify the studies on the safety and efficacy of UBC vs. conventional instruments for TSS. Data extraction and quality assessment were performed by two researchers independently. We used RevMan 5.4 software (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to analyze the data. Eight retrospective studies were included in the present work. This meta-analysis revealed that no significant differences in the preoperative JOA scores, the JOA scores at the last follow-up, the improvement rate of JOA scores, and the incidence of cerebrospinal fluid leakage/dura injury were detected between the two groups (p>0.05). However, there were significant differences in the operative time and intraoperative blood loss during single-level TLD [operative time: MD=-1.47, 95% CI (-1.86, -1.09), p<0.001; intraoperative blood loss: MD=-46.62, 95% CI (-53.83, -39.40), p<0.001], total operative time [MD=-56.88, 95% CI (-69.66, -44.10), p<0.001], total intraoperative blood loss [MD=-143.52, 95% CI (-212.49, -74.54), p<0.001], the incidence of neurological deterioration/nerve root injury [RR= 0.29, 95% CI (0.09, 0.91), p=0.03] between the groups. The application of UBC in TLD to treat TSS is safe and effective. UBC can significantly shorten operation time and reduce intraoperative blood loss compared to traditional surgical instruments. Moreover, it has the advantage of reducing perioperative nerve injury.

Does decompression adjacent to arthrodesis in the lumbar spine predispose patients to adjacent segment degeneration and disease: A retrospective analysis

BackgroundThe treatment for multi-level spinal stenosis in the setting of single-level instability is a common operative scenario for surgeons who treat degenerative lumbar spine pathology. However, there is conflicting evidence regarding the inclusion of adjacent “stable” levels in the arthrodesis construct because of the potential for iatrogenic instability placed on those segments with decompressive laminectomy alone. This study aims to determine whether decompression adjacent to arthrodesis in the lumbar spine is a risk factor for adjacent segment disease (AS Disease). MethodsA retrospective analysis identified consecutive patients over a three-year period who underwent single-level posterolateral lumbar fusion (PLF) in the setting of single or multi-level spinal stenosis. Patients were required to have a minimum of two-year follow-up. AS Disease was defined as the development of new radicular symptoms referable to a motion segment adjacent to the lumbar arthrodesis construct. The incidence of AS Disease and reoperation rates were compared between cohorts. Results133 patients met the inclusion criteria with an average follow-up of 54 months. Fifty-four patients had a PLF with adjacent segment decompression, and 79 underwent a single-segment decompression and PLF. 24.1% (13/54) of patients who had a PLF with adjacent level decompression developed AS Disease resulting in a 5.5% (3/54) reoperation rate. 15.2% (12/79) of patients who did not receive an adjacent level decompression developed AS Disease resulting in a reoperation rate of 7.5% (6/79). There was neither a significantly higher rate of AS Disease (p = 0.26) nor reoperation (p = 0.74) between the cohorts. ConclusionsDecompression adjacent to single-level PLF was not associated with an increased rate of AS Disease relative to single-level decompression and PLF.