Purpose The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.
Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5–C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5–C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods A 67-year-old man had vertebral canal stenosis at C5–C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5–C6 posterior decompressive laminectomy and excision of the cyst and C4–C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results The imaging studies identified grade I spondylolisthesis and a 3.3 × 4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions C5–C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5–C6 facet synovial cyst successfully treated with posterior laminectomy and C4–C6 fusion.
Thoracic spinal cord herniation (TSCH) is an unusual condition characterized by central displacement of the spinal cord through a dural defect, resulting in neurological impairment due to compression and vascular compromise. Different surgical techniques have been described to treat symptomatic patients with TSCH such as closure of the defect by primary sutures after reducing the spinal cord, widening the dural defect to prevent cord strangulation, or reducing the spinal cord and using a dural patch. Through a case presentation of a 62-year-old woman with TSCH, we describe step-by-step, a surgical technique for repair by reducing the spinal cord and using a dural patch. In our experience surgical reduction of the hernia will frequently improve the patient's symptoms and signs even in patients with longstanding deficits. The final objective of this surgical technique is to prevent recurrent herniation and progressive deficit.
Study DesignPilot test, observational study.ObjectiveTo evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons.MethodsDuring two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course.ResultsAnalysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p = 0.005) and lumbar spine modifier (46.6%, p = 0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p = 0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p = 0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p = 0.121) and sagittal thoracic modifier (12.9%, p = 0.081).ConclusionThis pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer.
Coluna/Columna. 2016;15(1):33-5 Original article/artigO Original/artículO Original JOse alfredO cOrredOr¹, fernandO flOres de araúJO¹, rOdrigO góes de MendOnça¹, nOel OizerOvici fOni¹, nelsOn astur¹, albertO OfenheiM gOtfryd¹, ricardO shigueaki galhegO uMeta¹, Maria fernanda silber caffarO¹, OsMar avanzi¹, rObert Meves¹ Recebido em 20/08/2015, aceito em 15/12/2015. NoNoperative versus operative treatmeNt of patieNts with degeNerative spoNdylolisthesis TraTamenTo conservador versus cirúrgico de pacienTes com espondilolisTese degeneraTiva TraTamienTo conservador conTra quirúrgico de pacienTes con espondilolisTesis degeneraTiva Original article/artigO Original/artículO Original AbstrActObjective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 -72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.
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