Subject(s)
Biocompatible Materials , Internal Fixators , Intervertebral Disc Degeneration/surgery , Ketones , Lumbar Vertebrae/surgery , Polyethylene Glycols , Spinal Fusion/statistics & numerical data , Titanium , Adult , Aged , Aged, 80 and over , Benzophenones , Bone Screws , Bone Transplantation , Female , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Male , Middle Aged , Polymers , Tomography, X-Ray Computed , Treatment Failure , Treatment OutcomeABSTRACT
OBJECTIVE: Surgical treatment of a pyogenic spondylodiscitis (PSD) involves a fixation and debridement of the affected segment combined with a specific antibiotic therapy. To achieve a proper stability and to avoid pseudarthrosis and kyphotic malposition many surgeons favour the interposition of an anterior graft. Besides autologous bone grafts titanium (TTN) cages have gained acceptance in the treatment of PSD. Polyetheretherketone (PEEK) cages have a more favourable modulus of elasticity than TTN. We compared both cage types. Primary endpoints were the rate of reinfection and radiological results. METHODS: From 2004 to 2013 51 patients underwent surgery for PSD with fixation and TTN or PEEK cage-implantation. While lumbar patients underwent a partial discectomy by the posterior approach, discs of the cervical and thoracic patients had been totally removed from anterior. Clinical and radiological parameters were assessed in 37 eligible patients after a mean of 20.4 months. 21 patients received a PEEK- and 16 patients a TTN-cage. RESULTS: A reinfection after surgery and 3 months of antibiotic therapy was not observed. Solid arthrodesis was found in 90.5% of the PEEK-group and 100% of the TTN-group. A segmental correction could be achieved in both groups. Nonetheless, a cage subsidence was observed in 70.3% of all cases. Comparison of radiological results revealed no differences between both groups. CONCLUSIONS: A debridement and fixation with anterior column support in combination with an antibiotic therapy appear to be the key points for successful treatment of PSD. The application of TTN- or PEEK-cages does not appear to influence the radiological outcome or risk of reinfection, neither does the extent of disc removal in this clinical subset.
Subject(s)
Biocompatible Materials , Bone Diseases, Infectious/surgery , Discitis/surgery , Internal Fixators , Ketones , Polyethylene Glycols , Titanium , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Arthrodesis , Benzophenones , Bone Diseases, Infectious/complications , Bone Diseases, Infectious/drug therapy , Bone Transplantation , Debridement , Discitis/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Polymers , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
Intraoperative electrical stimulation of the motor cortex is a sensitive method for intraoperative mapping and monitoring of this region. Two different stimulation techniques have been established, the bipolar and monopolar techniques. Controversy exists regarding the most suitable method. Both methods have advantages and disadvantages and different electrophysiological backgrounds. The present study is a review of the electrophysiological basis of direct cortical electrical stimulation of the motor cortex. Both methods are discussed and their field of application is presented.
Subject(s)
Electric Stimulation/methods , Monitoring, Intraoperative/methods , Motor Cortex/physiology , Neurosurgical Procedures/methods , Animals , Brain Mapping/methods , Cerebral Cortex/physiology , Electrodes, Implanted , Evoked Potentials, Somatosensory/physiology , Humans , Motor Cortex/surgery , Neuroanatomy/statistics & numerical data , Neurophysiology/methodsABSTRACT
OBJECT: The treatment of insular tumors is controversial. Surgical treatment is associated with a higher morbidity rate than other therapies. The present work presents a new method in which the descending motor pathways are monitored during surgery for insular tumors. METHODS: Intraoperative monitoring was performed in a combination of 2 techniques. The motor cortex was stimulated with a transcranial electrical stimulus. In addition, direct subcortical stimulation was performed with an electrical anodal monopolar stimulus. Compound motor action potentials (CMAPs) were recorded from target muscles. RESULTS: Fifteen patients were included in this preliminary study. Following transcranial stimulation, CMAPs were recorded in all cases. Subcortical stimulation was successful in 12 cases. Significant CMAP alterations were recorded in 5 patients. There were no false-negative results in the series. CONCLUSIONS: The technique presented here is a safe method. It allows a quantitative monitoring of motor function and functional mapping of the pyramidal tract during insular surgery.
