ABSTRACT
INTRODUCTION: Intraspinal facet cysts resistant to conservative treatment are treated surgically. Surgical treatment was generally resection and decompression, but complications of dural tear and recurrence sometimes occurred. We present good clinical results and rapid spontaneous resolution following treatment of five cases of lumbar intraspinal facet cyst after lateral lumbar interbody fusion (LLIF). METHODS: Multicenter series of five cases of lumbar intraspinal facet cyst with segmental instability treated with LLIF. The cross-sectional area (CSA) of the thecal sac and facet cyst on T2-weighted axial magnetic resonance imaging and the distance of facet joint (FJ) gap on axial computed tomography were measured preoperatively and postoperatively. Patient data and clinical and radiographic results were described. RESULTS: Of five patients, one was male and four were female, with an average age of 72.6 (61-76) years. The mean preoperative CSA of facet cyst was 40.09 mm2. In all cases, intraspinal facet cyst resolved within two weeks after LLIF and good clinical results were obtained. The mean CSA of the thecal sac increased from 64.18 mm2 preoperatively to 95.72 mm2 postoperatively. The mean distance of FJ gap increased from 0.8 (0-1.5) mm preoperatively to 3.1 (0.5-6.0) mm postoperatively. CONCLUSIONS: LLIF may be indicated for intraspinal facet cysts with segmental instability.
ABSTRACT
STUDY DESIGN: Case report. OBJECTIVE: To describe a new method of anterior cervical reconstruction with pedicle screws. SUMMARY OF BACKGROUND DATA: Anterior reconstruction after multilevel corpectomy is a challenging technique, and there are many reports on its complications. Graft dislodgement is one of the major complications after long cervical fusion. The main cause of failure seems to be a lack of stability in the conventional reconstruction technique. However, pedicle screws for posterior cervical reconstruction show remarkable stability. We describe a new technique of anterior cervical reconstruction with pedicle screws and fibular strut grafting. METHODS: Seven patients with multilevel cervical myelopathy were treated with this new reconstruction technique after a 4-level corpectomy. We describe this new technique and review the patients' clinical history, results of radiographical imaging, and outcomes. Clinical outcomes were assessed preoperatively and at 3 months postoperatively. Postoperative radiographs were assessed 3 months and 6 months postoperatively. RESULTS: The mean operative time was 182 minutes and the mean blood loss was 271 mL. The average Japanese Orthopaedic Association score for cervical myelopathy improved from 11.5 points preoperatively to 14.5 points 3 months postoperatively. No patients experienced major complications, such as neurological deterioration, infection, or massive blood loss. There was no case of reconstruction failure, graft dislodgement, migration, or screw displacement. CONCLUSION: To our knowledge, this is the first description of an anterior cervical reconstruction approach, using pedicle screws and fibular strut grafting after a 4-level corpectomy. It is likely that this technique will result in better clinical outcomes with fewer complications in the treatment of patients with multilevel cervical myelopathy.
