Percutaneous Pedicle Screw Fixation with Bone Cement Augmentation Under Epidural Anesthesia for Treatment of Kümmell Disease in Extremely Old Age.

BACKGROUND: In cases of Kümmell disease without neurologic deficit, percutaneous vertebroplasty or kyphoplasty has achieved short-term favorable outcomes. In the long term, recollapse of the augmented vertebral body and aggravation of kyphosis at the index level is often reported. Owing to medical comorbidities, elderly patients are often unsuited for extensive open spine surgery under general anesthesia. CASE DESCRIPTION: A 95-year-old man presented with a 1-month history of intractable back pain and gait disturbance. Magnetic resonance imaging revealed intravertebral avascular necrosis with fluid collection at the L4 vertebra. After postural reduction using a pillow in the supine position for 2 days, percutaneous pedicle screw fixation with bone cement augmentation was performed at the L3-5 level including L4 fracture under epidural anesthesia. Additional posterior column compression was performed to achieve restoration of spinal canal and lumbar lordosis. Severe back pain was reduced after surgery, and the patient was able to walk the day after surgery. CONCLUSIONS: To our knowledge, this is the first case of Kümmell disease in an extremely elderly patient in whom good clinical result was obtained after postural reduction, vertebral augmentation, and short segment percutaneous pedicle screw fixation under epidural anesthesia.

Comparison of Percutaneous Endoscopic Lumbar Diskectomy and Open Lumbar Microdiskectomy for Recurrent Lumbar Disk Herniation.

OBJECTIVE: To establish the appropriateness of transforaminal percutaneous endoscopic lumbar diskectomy (PELD) by comparing it with open lumbar microdiskectomy (OLM) for surgical treatment of recurrent lumbar disk herniation. METHODS: We retrospectively analyzed 83 patients who underwent revision surgery (group A: PELD, 35 cases; group B: OLM, 48 cases) for recurrent lumbar disk herniation between March 2009 and April 2014. All of the patients were followed > 12 months. To evaluate outcomes, we checked the leg and back visual analog scale (VAS), Oswestry Disability Index (ODI), complications, and recurrence for all patients. RESULTS: The mean improvement of VAS for leg was 5.97 ± 0.98 for group A and 5.62 ± 1.42 for group B (p = 0.194). The mean improvement of VAS for back pain was 2.71 ± 1.30 for group A and 2.29 ± 1.41 for group B (p = 0.168). The mean improvement of ODI scores was 28.86 ± 3.93 for group A and 28.00 ± 4.22 for group B (p = 0.350). Total surgery-related complications were none for group A and nine for group B (p = 0.009). Group A had one subject with surgery-related neurologic symptoms and group B had four (p = 0.391). Recurrence occurred in two patients in group A and seven patients in group B (p = 0.291). CONCLUSION: PELD and OLM have favorable clinical outcomes in patients with recurrent lumbar disk herniation, and PELD results in fewer complications compared with OLM. Therefore, PELD may be a better alternative to OLM for patients with recurrent lumbar disk herniation.

The clinical characteristics of lower lumbar osteoporotic compression fractures treated by percutaneous vertebroplasty : a comparative analysis of 120 cases.

OBJECTIVE: The purpose of this study is to provide accurate understanding of clinical presentations and surgical outcomes as well as to identify the unique characteristics of lower lumbar osteoporotic compression fracture (OCF). METHODS: Clinical data were collected from 120 patients who had L3, L4 or L5 percutaneous vertebroplasty (PVP) performed from 2008 to 2012 at the single institute. L4 or L5 PVP patients were classified into group 1 and group 2 was for L3 PVP patients. Medical records were retrospectively investigated at 1 month after PVP. Long term follow-up results were obtained at a median value of 22 months after PVP. RESULTS: 75% of the patients in group 1 were not associated with traumatic events, 71% presenting with leg radiating symptoms and 46% requiring an additional decompressive surgery, more often than those in group 2. These differences are statistically significant (p<0.05). The short term medical record review demonstrated that only 73% of patients in group 1 were ameliorated with regard to back motion pain, whereas those in group 2 reported 87.7% rates of amelioration in identical category (p<0.05). The long term follow up confirmed a significantly worse outcome in group 1, with only 55.7% of patients reporting amelioration in their pain or functional status, but 71.7% rate of amelioration in group 2. CONCLUSION: The OCFs at the L4 or L5 level have different clinical characteristics from those at upper levels of the lumbar spine.

Clinical and radiological findings of nerve root herniation after discectomy of lumbar disc herniation.

The authors report 2 cases of nerve root herniation after discectomy of a large lumbar disc herniation caused by an unrecognized dural tear. Patients complained of the abrupt onset of radiating pain after lumbar discectomy. Magnetic resonance imaging showed cerebrospinal fluid signal in the disc space and nerve root displacement into the disc space. Symptoms improved after the herniated nerve root was repositioned. Clinical symptoms and suggestive radiologic image findings are important for early diagnosis and treatment.

Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage.

OBJECT: An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. METHODS: The authors retrospectively reviewed the cases of 60 patients with pyogenic spondylodiscitis treated by anterior debridement between January 2003 and April 2005. Fusion using either cages or iliac bone struts was performed during the same course of anesthesia followed by posterior fixation. Twenty-three patients underwent fusion with autologous iliac bone strut, and 37 patients underwent fusion with 1 of the 3 types of cages. RESULTS: The infections resolved in all patients, as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. Patients in both groups were evaluated in terms of their preoperative and postoperative clinical and imaging findings. CONCLUSIONS: Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.

Lymphocele formation after anterior lumbar interbody fusion at L4-5. Case report.

In this report, the authors present the case of patient with a lymphocele in the retroperitoneal area following anterior lumbar interbody fusion at L4-5. A lymphocele is a rare complication of spinal operations, especially lower lumbar spinal surgeries. The authors discuss this complicating factor and describe its features and treatments.