Surgical Reconstruction Using a Flanged Mesh Cage without Plating for Cervical Spondylotic Myelopathy and a Symptomatic Ossified Posterior Longitudinal Ligament.

OBJECTIVE: We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL). METHODS: Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months. RESULTS: In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups. CONCLUSION: The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.

Can Three Months of Teriparatide Be One of Treatment Options for Osteoporotic Vertebral Compression Fracture Patients?

OBJECTIVE: Osteoporosis is one of the most common causes of vertebral compression fractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the first anabolic agent for the treatment of osteoporosis. The aim of this study was to determine whether 3 months of teriparatide could be effective for patients with osteoporotic VCF at the thoracolumbar spine. METHODS: We reviewed 25 patients with thoracolumbar osteoporotic compression fractures between July 2012 and October 2016 who could be followed up for more than 1 year. Patients were divided into 2 groups depending on the use of teriparatide: 14 patients received teriparatide through subcutaneous injection (group I) and 11 patients did not receive teriparatide (group II). Demographic data, bone mineral density, hospitalization period, changes in the visual analogue scale (VAS) score, body mass index, and medical history such as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were also reviewed to evaluate vertebral body compression percentages and kyphotic angles. RESULTS: Overall changes of VAS score between injury and follow-up were statistically improved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvement at a specific time between the 2 groups was not statistically significant. Overall kyphotic angle and compression percentage between injury and follow-up time were increased in group II than those in group I, although the difference between the 2 groups was not statistically significant. CONCLUSION: Three-month of teriparatide did not show protective effects on progression of fractured vertebral body collapse or kyphotic changes in patients with osteoporosis.

Minimum 3-year outcomes in patients with lumbar spinal stenosis after bilateral microdecompression by unilateral or bilateral laminotomy.

OBJECTIVE: Lumbar spine stenosis (LSS) can result in symptomatic compression of the neural elements, requiring surgical treatment if conservative management fails. Minimally invasive surgery has come to be more commonly used for the treatment of LSS. The current study describes outcomes of bilateral microdecompression by unilateral or bilateral laminotomy (BML) for degenerative LSS after a minimum follow-up period of 3 years and investigates factors that result in a poor outcome. METHODS: Twenty-one patients who were followed-up for at least 3 years were included in this study. For clinical evaluation, the Japanese Orthopedic Association (JOA) scoring system for low back pain was used. The modified grading system of Finneson and Cooper was used for outcome assessment. Radiographic evaluation was also performed for spondylolisthesis, sagittal rotation angle, and disc height. RESULTS: Twenty-one patients (10 men, 11 women) aged 53-82 years (64.1±8.9 years) were followed-up for a minimum of 3 years (36-69 months). During follow-up, two patients underwent reoperation. Average preoperative JOA score and clinical symptoms, except persistent low back pain, improved significantly at the latest follow-up. There were no significant differences in radiological findings preoperatively and postoperatively. Thirteen patients (61.9%) had excellent to fair outcomes. CONCLUSION: BML resulted in a favorable and persistent outcome for patients with degenerative LSS without radiological instability over a mid-term follow-up period. Persistent low back pain unrelated to postoperative instability adversely affects mid-term outcomes.

Redundant nerve roots of cauda equina mimicking intradural disc herniation: a case report.

Redundant Nerve Roots (RNRs) is an uncommon clinical condition characterized by a tortuous, serpentine, large and elongated nerve root of the cauda equina. To our knowledge, most cases of RNRs are associated with lumbar stenosis, and RNRs associated with lumbar disc herniation has not been reported until now. Here we present a rare case of unusual RNRs associated with lumbar disc herniation mimicking intradural disc herniation.