Benign neurological recovery with low recurrence and low peridural fibrosis rate in pediatric disc herniations after lumbar microdiscectomy.

Lumbar disc herniation (LDH) is a very rare clinical entity in the pediatric age group, therefore only a few clinical studies have until now investigated the clinical behavior of pediatric LDH. The natural clinical history, postoperative neurological recovery with radiological follow-up and quality of life related to the disorder continue to be unknown. We prospectively planned and designed two groups of LDH patients scheduled for surgery in this study. The operations were performed by the same surgeon in a randomized fashion. The first group consisted of pediatric patients and the second group of adult patients. Both groups contained 32 cases. Postoperative neurological recovery was assessed using the visual analog scale and Aberdeen Low Back Pain Scale. Postoperative peridural fibrosis was also evaluated in postcontrast magnetic resonance sections. After 3 years of follow-up, all parameters were significantly better in the pediatric LDH group with no recurrence of the disease. The pediatric LDH group was postoperatively better than the adult group both clinically and radiologically. Although LDH seems a catastrophic disease in the pediatric age group, the clinical picture and neurological recovery have a significantly more benign course than in adult patients even in operated cases.

The accuracy of multi-slice three-dimensional computerized tomography on the verification of the pedicle screw trajectory.

The purpose of our study was to determine the diagnostic power of three-dimensional reformatted multi-slice computerized tomography (CT) images on misplaced pedicle screws in spinal surgery. Eighty-four consecutive patients with 458 screws in situ were investigated prospectively using both axial CT slices and reformatted images after operation by two blinded investigators. All the screw misplacements were documented and the differences between the two imaging modalities were recorded. Axial CT slices were able to show only 23 of 60 misplaced pedicle screws; multislice CT was three times more powerful in the diagnosis of pedicle screw complications in spinal surgery (p<0.05). We concluded that multi-slice CT reconstruction should be the primary diagnostic tool after screw implantation in the human spine.

Mitomycin protection of peridural fibrosis in lumbar disc surgery.

OBJECT: In this prospective, randomized clinical study the authors sought to evaluate the effects of locally applied mitomycin C on peridural fibrosis during lumbar microdiscectomy. METHODS: Patients undergoing lumbar disc surgery were randomly divided into 2 groups. Thirty patients had 1 mg/ml mitomycin C applied at the site of discectomy for 5 minutes, and 30 age- and sex-matched patients underwent lumbar microdiscectomy without mitomycin C application as the control group. The groups were compared for degree of postoperative neurological function, radicular/back pain, and degree of peridural fibrosis on MR imaging 6 months after the operation. RESULTS: The median follow-up was 18 months. No serious drug adverse effects and no clinically significant laboratory adverse effects were reported in patients in the mitomycin C group. Patients in both groups showed similar clinical recoveries postoperatively. On postoperative evaluation of the MR images, pain scores, and neurological function, patients given mitomycin C have shown no reduction of peridural fibrosis either clinically or radiographically. CONCLUSIONS: Mitomycin C is easy to use and safe in patients undergoing lumbar microdiscectomy. However, no benefit was observed either clinically or radiographically in this study.

Complete cranium bifidum without scalp abnormality. Case report.

Cranium bifidum is an unusual lesion in newborns. The majority of previously reported cases have described enlarged parietal foramina with some scalp and other congenital abnormalities. In this report the authors present the first case of complete cranium bifidum without any other anomaly. The cranial defect persisted for 3 years during the follow-up period. No hereditary or familial transition has been observed. The authors conclude that such an extremely rare occurrence of complete cranium bifidum may be a result of a coincidental mutation.

Lumbar facet joint angle and its importance on joint violation in lumbar microdiscectomy.

OBJECTIVE: We investigated facet joint angle at the level of the nucleus pulposus in herniated disks and documented the importance of this angle in preserving articulation and surgical view in patients undergoing lumbar microdiscectomy. METHODS: In this prospective study using pre- and postoperative magnetic resonance imaging scans, two blinded radiologists measured and inspected the facet joint angles in 168 patients. Patients were treated with single-level, unilateral, lumbar microdiscectomy. Postoperatively, patients were divided into two groups according to whether or not any portion of the facet joint had been violated during surgery. Using the magnetic resonance imaging scans, the angles of the facet joints were measured and then correlated with whether or not the facet joint was preserved. RESULTS: The follow-up period for this study was 6 months. Postoperative radicular and back pain during the follow-up period and the need for opioids in the early postsurgery period (48 h) were higher in the nonpreserved group, but these differences were not statistically significant (P > 0.05). If the facet joint angle at the disc was lower than 35 degrees in the horizontal plane, articulation cannot be preserved. However, if this angle is greater than 35 degrees, articulation may be preserved and the surgical view is satisfactory for lumbar microdiscectomy. CONCLUSION: The angle of the lumbar facet joint is important to protect articulation during lumbar microdiscectomy, and violating the facet joint may affect early postoperative pain. A facet angle of less than 35 degrees does not allow for a safe surgical corridor in which to use instruments, nor does it provide a satisfactory view for the surgeon.

Does shaving the incision site increase the infection rate after spinal surgery?

STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE: To determine whether shaving the incision site before spinal surgery causes postsurgical infection. SUMMARY OF BACKGROUND DATA: Spine surgeons usually shave the skin of the incision site immediately before surgery is performed. However, evidence from some surgical series suggests that presurgical shaving may increase the postsurgical infection rate. To our knowledge, no previously published studies have addressed this issue. METHODS: A total of 789 patients scheduled to undergo spinal surgery were randomly allocated into 2 groups: those in whom the site of operation was shaved immediately before surgery (shaved group; 371 patients) and the patients in whom presurgical shaving was not performed (unshaved group; 418 patients). The mean duration of anesthesia and the infection rates in both groups were recorded and compared. RESULTS: The duration of anesthesia did not differ in the 2 groups (P > 0.05). A postoperative infection developed in 4 patients in the shaved group and in 1 patient in the nonshaved group (P < 0.01). CONCLUSIONS: The shaving of the incision site immediately before spinal surgery may increase the rate of postoperative infection.

A comparison of changes over time in cervical foraminal height after tricortical iliac graft or polyetheretherketone cage placement following anterior discectomy.

OBJECT: The authors prospectively evaluated cervical foraminal height changes after anterior cervical discectomy and fusion. To their knowledge, this prospective study is the first in which foraminal height changes over time are compared following the placement of a tricortical graft or a polyetheretherketone (PEEK) cage. METHODS: The patients were randomly divided in two groups. In one group, 30 patients underwent anterior cervical microdiscectomy and free bone graft (FBG) insertion at 46 levels via the Smith-Robinson technique. The FBG was harvested from the right iliac crest. Another 35 patients underwent the same operation, but fusion was provided by the insertion of PEEK intervertebral cages at 41 levels. Fusion status and the C2-7 Cobb angle, interspace height, and foraminal height changes were observed on anterior, lateral, and oblique radiographs obtained at the 18-month follow-up examination. There were no differences between the groups with regard to clinical recovery, fusion status, and Cobb angle. A significant interspace height reduction was observed in the FBG group during the 1st postoperative month. In the FBG group, the mean heights (+/- standard deviation) of the foramina were 8.2 +/- 2.7 mm preoperatively, 10.8 +/- 2.6 mm on postoperative Day 2, and 8.1 +/- 1.5 mm after 18 months of follow up. In the PEEK cage group, the mean heights were 8.4 +/- 2.8 mm preoperatively, 10.3 +/- 1.1 mm on postoperative Day 2, and 9.6 +/- 1.2 mm after 18 months of follow up. The increase in foraminal height was significantly preserved at the 6th, 12th, and 18th months in the cage group. CONCLUSIONS: In both groups the foraminal height increased sufficiently and the nerve root was decompressed postoperatively. The PEEK cages may provide sufficient preservation of foraminal height even 1.5 years after the operation.