The role of spinal fusion in surgery for lumbar spinal stenosis: a review.

The authors undertook a review of the literature and analysis of the local surgical experience for lumbar stenosis to define the role of simultaneous arthrodesis in the treatment of patients undergoing decompression for spinal stenosis. The restrained use of spinal fusion is recommended in spinal stenosis surgery because of the coexisting medical problems in the elderly patient population and the higher associated complication rate with spinal fusion and instrumentation. A spinal fusion is recommended when decompression is performed in an area of segmental instability as manifested by gross movement on flexion--extension radiographs; when the decompression coincides with an area of degenerative instability, as with scoliosis or spondylolisthesis; or when the decompression creates an iatrogenic instability by the disruption of the posterior elements.

A clinical and neuropathologic study of silk suture as an embolic agent for brain arteriovenous malformations.

Purpose: To evaluate the safety and efficacy of silk suture as an agent for preoperative embolization of cerebral arteriovenous malformations.

Methods: Clinical and histopathologic results were analyzed in six patients who underwent embolization of cerebral arteriovenous malformations using silk suture in combination with other agents.

Results: Three of the patients treated with silk hemorrhaged after embolization, and two of these patients died.

Long-term evaluation of decompressive surgery for degenerative lumbar stenosis.

One-hundred patients who had undergone decompressive surgery for lumbar stenosis between 1980 and 1985 were evaluated as to their long-term outcome. Four patients with postfusion stenosis were included. A 5-year follow-up period was achieved in 88 patients.