Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis.

STUDY DESIGN: Prospective clinical study. OBJECTIVE: To test whether elastic stabilization with the Dynesys system (Zimmer Spine, Minneapolis, MN) provides enough stability to prevent further progression of spondylolisthesis as well as instability after decompression for spinal stenosis with degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: In spinal stenosis with degenerative spondylolisthesis, decompression and fusion is widely recommended. However, patients have donor site pain. In 1994, a dynamic transpedicular system (Dynesys) was introduced to the market, stating that stabilization is possible without bone grafting. METHODS: A total of 26 patients (mean age 71 years) with lumbar spinal stenosis and degenerative spondylolisthesis underwent interlaminar decompression and dynamic stabilization with the Dynesys system. Minimum follow-up was 2 years. Operative data, clinical outcome, and plain and flexion/extension radiographs were obtained and compared to preoperative and postoperative data. RESULTS: Mean leg pain decreased significantly (P < 0.01), and mean walking distance improved significantly to more than 1000 m (P < 0.01). There were 5 patients (21%) who still had some claudication. A total of 21 patients (87.5%) would undergo the same procedure again. Radiographically, no significant progression of spondylolisthesis could be detected. The implant failure rate was 17%, and none of them were clinically symptomatic. CONCLUSIONS: In elderly patients with spinal stenosis with degenerative spondylolisthesis, dynamic stabilization with the Dynesys system in addition to decompression leads to similar clinical results as seen in established protocols using decompression and fusion with pedicle screws. It maintains enough stability to prevent further progression of spondylolisthesis or instability. With the Dynesys system, no bone grafting is necessary, therefore, donor site morbidity can be avoided.

Atlantoaxial osteoarthritis: case series and review of the literature.

The intention of this study is to present our experience in the surgical treatment of painful atlantoaxial osteoarthritis (AAOA) and review the literature on this subject. Osteoarthritis of the atlantoaxial joints is more common than is generally suspected. It has a prevalence between 5 and 18%. Only a minority of patients becomes symptomatic suffering from severe suboccipital pain, irradiating into the occiput, vertex and sometimes as far as the eyes. Most often, these patients can successfully be treated conservatively. Some of these patients however require operative treatment. The study includes five patients with painful AAOA (one posttraumatic, four idiopathic) not responding to conservative treatment for a minimum of six months. Rheumatoid arthritis was excluded. All but one patient were female and all but one patient were over 50 years old (mean 64 years). The origin of pain was confirmed by diagnostic C1-C2 facet blocks in all patients. The patients were treated with a C1-C2 transarticular screw fixation and Gallie type fusion. Patients were followed clinically and radiologically for a minimum of 24 months. Mean follow-up was 38 months (24-48). In all patients the typical pain disappeared immediately after surgery and has not reoccurred. Pain intensity on the VAS decreased from 100 to 34. At the latest follow-up radiologically solid fusion and stable implants were found in all cases. All five patients would undergo this surgery for the same condition again. C1-C2 fusion effectively relieves occipitocervical pain in AAOA non responsive to conservative treatment.

Osteomyelitis of the cervical spine: a potentially dramatic disease.

Osteomyelitis of the cervical spine is a rare disease, representing only 3% to 6% of all cases of vertebral osteomyelitis. In contrast with other locations of spinal infections, osteomyelitis of the cervical spine can be a much more dramatic and rapidly deteriorating process, leading to early neurologic deficit. Thus, the disease must be diagnosed quickly and appropriate therapy initiated as soon as possible. The clinical course, therapy, and outcome of 15 patients treated for osteomyelitis of the cervical spine are presented. Nine of 15 patients presented with a neurologic deficit at the time of diagnosis. Surgical treatment consisted of radical debridement of the infected bone and either immediate bone grafting and stabilization as a one-step procedure or interval antibiotic treatment before bone grafting and surgical stabilization as a second procedure. A favorable outcome was achieved by early and aggressive surgical intervention, including complete resolution of neurologic deficits in more than 50% of the patients and complete bony fusion in all but one patient. The authors prefer additional posterior rather than anterior stabilization alone to perform fusion over a shorter distance involving only the infected segments.