Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old

OBJECTIVE: Lumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65. METHODS: Retrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment. RESULTS: Pain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05). CONCLUSION: Microdiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery.

Prognostic Factors of Locking Unicortical System in Internal Fixation for Cervical Spine Lesions

Although anterior cervical plate provide excellent fixation for anterior column, the potential risk for injury to spinal cord or soft tissue has been the reason why they have not gained universal acceptance. For this reason, anterior cervical locking plating systems were designed to avoid such surgical complications. The authors reviewed 98 patients who underwent anterior cervical fusion with anterior cervical locking unicortical system during the period of January 1995 to December 1997. Mean follow up period was 8.4months. Morscher plate placement was done in 24 and Orion plate was applied in 74. We compare the safety and efficacy of these tow plates. The two groups were comparable in demographic details, mean age(Morscher 41, Orion 47) average fusion level(Morscher 1.25, Orion 1.55) and fusion rate(Morscher 95.8%, Orion 100%). For comparison of hardware related complication, two patients(2.7%) showed screw loosening without without need for reoperation in Orion plate group. In Morscher plate group, 1 patient(4.1%) developed plate fracture and 1 patient (4.1%) developed screw loosening, but did not require delete(re) operation. Non-hardware related complications in Morscher group were seen in 2 patients(8.2%): one delete CSF leakage and the other being postoperative hematoma collection. In Orion plate group, complications were developed in 9 patients(12%): two nerve injuries(recurrent laryngeal and hypoglossal nerve), two CSF leakages, two wound infections, one postoperative hematoma collection, two donor graft site pains. Reoperations were done in two cases(2%) due to two postoperative hematoma collection one in Morscher plate group and one in Orion plate group. In one level fusion, longer operation time was required in Morscher plate group(217+/-93.7min) compared to Orion plate group(157+/-47min)(p<0.05). In this study two types of anterior cervical locking plate and screw system had good bony fusion and cervical stabilization with few instrument related complication. Moreover, allograft bone fusion with anterior cervical locking plate and screw system had good solid bony fusion without donor site morbidity. Instrument related complications were more common in Morscher locking plate and screw system.

Combined Instrumentation in Lumbar Spondylolisthesis

OBJECTIVE: The purpose of this retrospective study is to review the clinical results, fusion rate, quality of reduction and stabilization and effects of cages in the intervertebral space in spondylolisthesis. METHODS: Authors reviewed retrospectively 30 patients who were treated with instrumentation and posterior lumbar interbody fusion(PLIF) between April 1996 to December 1997. RESULTS: Among 30 patients, 13 patients were degenerative type and 17 were isthmic types. The most commonly involved level was L4-5(16cases, 53.3%). Fusion was obtained in 29 patients(96.7%). Clinically, 14 of 17 patients(82.3%) showed excellent or good results in isthmic group, and 11 of 13 patients(84.6%) showed excellent or good results in degenerative group. Postoperative complications developed in three cases(10%), wound infection two cases(6.6%), cage retrodisplacement one case(3.3%). CONCLUSION: PLIF combined with transpedicular instrumentation in lumbar spondylolisthesis showed in all clinical results and fusion rate.