Cervical spine: degenerative conditions.

Degenerative cervical spine disorders will affect up to two-thirds of the population in their lifetime. While often benign and episodic in nature, cervical disorders may become debilitating resulting in severe pain and possibly neurologic sequelae. Non-operative treatment continues to play an important role in treating these patients, with medications, therapy and interventional pain injections playing increasing roles in treatment. Surgical treatment including anterior and posterior decompression and fusion have been effective treatments of many cervical disorders, but may lead to significant problems including adjacent level disease. Laminotomy/foraminotomy and total disc arthroplasty may avoid some of these problems while providing similar clinical results. Ongoing clinical trials and studies are helping to define the role of these new technologies in treatment of patients with degenerative cervical disorders, although their greater benefit has yet to be proven.

Aseptic meningitis after microdiscectomy: description of a case and review of the literature.

BACKGROUND CONTEXT: Aseptic meningitis has rarely been described after spinal surgery. No reports of aseptic meningitis exist after microdiscectomy in the literature. PURPOSE: To report on a case of aseptic meningitis in a patient after undergoing laminotomy and microdiscectomy at L4-L5. STUDY DESIGN/SETTING: Case report. METHODS: A case of aseptic meningitis is reported after microdiscectomy at L4-L5 in a 31-year-old man. In this case, a patient underwent L4-L5 laminotomy and microdiscectomy for weakness and pain. He subsequently presented 3 days after with neck pain, photophobia, and fever. RESULTS: Cerebrospinal fluid (CSF) examination subsequently revealed a pattern for aseptic meningitis. CONCLUSIONS: Presentation of aseptic meningitis after microdiscectomy is a rare but important diagnosis to consider. Examination of CSF is an important procedure to rule out the more dangerous diagnosis of bacterial meningitis.

Static versus dynamic plating for multilevel anterior cervical discectomy and fusion.

BACKGROUND CONTEXT: Dynamic anterior plates have been popularized to promote cervical spine fusion by allowing controlled settling, thereby promoting load sharing across the construct. To date these proposed benefits have been largely theoretical and there are no studies confirming any benefits over more traditional static plates. PURPOSE: To compare the clinical and radiographic outcomes of patients undergoing an instrumented multilevel anterior cervical discectomy and fusion (ACDF) with either a static or dynamic plate design. STUDY DESIGN: A retrospective clinical and radiographic study. PATIENT SAMPLE: From 1997 to 2002, 52 patients with either radiculopathy or myelopathy underwent two- or three-level ACDF with either static or dynamic plate fixation. OUTCOME MEASURES: Functional outcome, fusion status, radiographic measurements. METHODS: A statically locked plating system was used in 21 patients, and a dynamic plating system was used in 31 patients. Functional outcome, fusion status, plate migration, settling, and adjacent-level disc space impingement were evaluated. RESULTS: Clinical outcome was found to be similar between the statically and dynamically plated groups. Eighty-four percent of patients in both groups experienced good or excellent results at final follow-up. We observed a higher rate of nonunion in patients treated with a dynamic plate (16% [5 of 31]) compared with a rate of 5% (1 of 21) in those patients treated with a static plate (p=.05). Settling of the construct and plate migration was similar between the study groups at all time points. CONCLUSIONS: This study failed to confirm our hypothesis that a dynamic plate (that allows angular motion between the screws and plate) confers any clinical or radiographic advantage over earlier design static plates. A higher rate of nonunion was actually seen in the dynamically plated patients; however, clinical results were similar between the two groups.

Unusual presentation of osteoblastoma in a patient with idiopathic scoliosis after posterior spinal fusion.

BACKGROUND CONTEXT: Few studies have described the diagnosis of osteoblastoma of the spine as a cause of scoliosis. These reports have described the tumor in conjunction with initial presentation of painful scoliosis. This case report presents a case of osteoblastoma 9 years removed from diagnosis and fusion of idiopathic scoliosis in the thoracic spine. PURPOSE: To report the late presentation of an osteoblastoma of the thoracic spine 9 years after posterior spinal fusion for scoliosis. STUDY DESIGN: Case report. METHODS: A 25-year-old man presented with thoracolumbar back pain and progressive neurological deficit 9 years after posterior spinal fusion for idiopathic scoliosis. Magnetic resonance imaging of the thoracic spine indicated the presence of a mass in the spinal canal causing cord compression. The patient underwent decompression with resection of the mass which was found to be an aggressive osteoblastoma. RESULTS: The patient enjoyed a full neurological recovery and has subsequently developed a recurrence at 13 months. CONCLUSIONS: We present osteoblastoma as a possible cause of low back pain and neurological deficit postfusion that should be considered in a differential diagnosis.