Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4-12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial.

Objectives: To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation.

Methods: Patients with sciatica lasting 4-12 months and lumbar disc herniation at the L4-L5 or L5-S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF-36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery.

Discectomy Compared with Standardized Nonoperative Care for Chronic Sciatica Due to a Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial with 2-Year Follow-up.

Background: Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known.

Microdiscectomy Is More Cost-effective Than a 6-Month Nonsurgical Care Regimen for Chronic Radiculopathy.

Background: A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy.

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders.

Background: Few reports in the literature have described the long-term outcome of postoperative infection from the patient perspective. The aim of the present study was to determine if complicated surgical site infection (SSI) affects functional recovery and surgical outcomes up to 2 years after posterior instrumented thoracolumbar surgery for the treatment of degenerative disorders.

Methods: This retrospective cohort study involved patients who had been enrolled in a previous randomized controlled trial that examined antibiotic use for open posterior multilevel thoracolumbar or lumbar instrumented fusion procedures.

Biomechanical comparison of 3 types of transdiscal fixation implants for fixing high-grade L5/S1 spine spondylolisthesis.

Background Context: There are several options for the stabilization of high-grade lumbosacral spondylolisthesis including transdiscal screws, the Bohlman technique (transdiscal fibular strut) and the modified Bohlman technique (transdiscal titanium mesh cage). The choice of an optimum construct remains controversial; therefore, we endeavoured to study and compare the biomechanical performance of these 3 techniques.

Purpose: The aim of this study was to compare 3 types of transdiscal fixation biomechanically in an in vitro porcine lumbar-sacral spine model.

Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months.

Background: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months.

Methods: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed.

The Effect of Prolonged Postoperative Antibiotic Administration on the Rate of Infection in Patients Undergoing Posterior Spinal Surgery Requiring a Closed-Suction Drain: A Randomized Controlled Trial.

Background: Closed-suction drains are frequently used following posterior spinal surgery. The optimal timing of antibiotic discontinuation in this population may influence infection risk, but there is a paucity of evidence. The aim of this study was to determine whether postoperative antibiotic administration for 72 hours (24 hours after drain removal as drains were removed on the second postoperative day) decreases the incidence of surgical site infection compared with postoperative antibiotic administration for 24 hours.

Posterolateral Versus Posterior Interbody Fusion in Lumbar Degenerative Spondylolisthesis.

Study Design: This was a retrospective study of 2 different fusion techniques for the treatment of lumbar degenerative spondylolisthesis.

Objective: To determine whether posterior lumbar interbody fusion (IF) is associated with improved patient-rated satisfaction and functional outcome when compared with posterolateral fusion (PLF).

Summary Of Background Data: IF and PLF are widely used surgical approaches in the treatment of spondylolisthesis.

Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively.

Study Design: A prospective cohort study of consecutive patients.

Objective: Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively.

Summary Of Background Data: Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms.

Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types.

OBJECTIVE Previous studies have focused on Type II odontoid fractures and have failed to report on the effect of other C-2 fracture types on treatment and outcome. The purpose of this study was to compare patient characteristics, cause of injury, predisposing factors to fracture, treatments, and mortality rates among C-2 fracture types in a cohort of elderly patients 70 years of age and older. METHODS A retrospective cohort study design was used.

Obesity and spinal epidural lipomatosis in cauda equina syndrome.

Background Context: Although lumbar disc herniations are common, only a small portion of these herniations lead to cauda equina syndrome (CES), which is an uncommon but debilitating disorder. Why some patients with herniation develop CES, when most do not, remains unknown. Preexisting subclinical epidural lipomatosis may limit canal space such that an otherwise benign herniation causes CES.

Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis.

OBJECTIVE The object of this study was to determine the association between postoperative sagittal spinopelvic alignment and patient-rated outcome measures following decompression and fusion for lumbar degenerative spondylolisthesis. METHODS The authors identified a consecutive series of patients who had undergone surgery for lumbar degenerative spondylolisthesis between 2008 and 2012, with an average follow-up of 3 years (range 1-6 years). Surgery was performed to address the clinical symptoms of spinal stenosis, not global sagittal alignment.

Radiographic assessment of degenerative lumbar spinal stenosis: is MRI superior to CT?

Objective: To determine the reliability and dependability of magnetic resonance imaging (MRI) and computerized tomography (CT) in the assessment of lumbar spinal stenosis and correlate the qualitative assessment to both a quantitative assessment and functional outcome measures. Multiple studies have addressed the issue of CT and MRI imaging in lumbar spinal stenosis. None showed superiority of one modality.

Does the wait for lumbar degenerative spinal stenosis surgery have a detrimental effect on patient outcomes? A prospective observational study.

Background: Waits for elective spine surgery are common in Canada. We examined whether a prolonged wait for surgery for lumbar degenerative spinal stenosis was detrimental to outcome.

Methods: In this prospective observational study, we enrolled 166 consecutive patients referred to our centre for treatment of lumbar degenerative spinal stenosis between 2006 and 2010.

Influence of graft size on spinal instability with anterior cervical plate fixation following in vitro flexion-distraction injuries.

Background Context: Anterior cervical discectomy and fusion with plating (ACDFP) is commonly used for the treatment of distractive-flexion cervical spine injuries. Despite the prevalence of ACDFP, there is little biomechanical evidence for graft height selection in the unstable trauma scenario.

Purpose: This study aimed to investigate whether changes in graft height affect the kinematics of instrumented ACDFP C5-C6 motion segments in the context of varying degrees of simulated facet injuries.

The relationship between the duration of acute cauda equina compression and functional outcomes in a rat model.

Study Design: Immunohistochemical and behavioral study using a rat model of acute cauda equina syndrome (CES).

Objective: To determine the effect of duration of extradural cauda equina compression (CEC) on bladder, sensory, and motor functions.

Summary Of Background Data: Cauda equina syndrome is a devastating injury treated with surgical decompression.

Systemic inflammatory response syndrome in patients with spinal cord injury: does its presence at admission affect patient outcomes? Clinical article.

Object: The object in this study was to determine whether the presence of systemic inflammatory response syndrome (SIRS) in patients with traumatic spinal cord injury (SCI) on admission is related to subsequent clinical outcome in terms of length of stay (LOS), complications, and mortality.

Methods: The authors retrospectively reviewed the charts of 193 patients with acute traumatic SCI who had been hospitalized at their institution between 2006 and 2012. Patients were excluded from analysis if they had insufficient SIRS data, a cauda equina injury, a previous SCI, a preexisting neurological condition, or a condition on admission that prevented appropriate neurological assessment.

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation.

Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication.

Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial.

Background Context: Thoracolumbar burst fractures have good outcomes when treated with early ambulation and orthosis (TLSO). If equally good outcomes could be achieved with early ambulation and no brace, resource utilization would be decreased, especially in developing countries where prolonged bed rest is the default option because bracing is not available or affordable.

Purpose: To determine whether TLSO is equivalent to no orthosis (NO) in the treatment of acute AO Type A3 thoracolumbar burst fractures with respect to their functional outcome at 3 months.

A rare case of atlantooccipital dissociation in the context of occipitalization of the atlas, with a 2-year follow-up: case report.

Atlantooccipital dislocation (AOD) is a rare and often fatal injury. In cases of survival, residual deficits are severe and often include cranial nerve palsy, quadriplegia, or respiratory issues. Occipitalization is defined as partial or complete congenital fusion of the occiput to the atlas and is exceptionally rare.

A biomechanical assessment of soft-tissue damage in the cervical spine following a unilateral facet injury.

Background: Unilateral cervical spine facet injuries encompass a wide spectrum, including subluxations, dislocations, and fractures, and the instability produced varies greatly. The extent of anatomical disruption secondary to a unilateral facet injury is poorly understood, and few biomechanical studies have quantified the associated kinematics. The purpose of this study was to develop an experimental method that reliably produces an impending unilateral facet dislocation (perched facet) in cadaveric cervical spines and to identify the soft-tissue damage and resulting changes in cervical spine range of motion and neutral zone associated with this injury.

The importance of the posterior osteoligamentous complex to subaxial cervical spine stability in relation to a unilateral facet injury.

Background Context: Unilateral facet disruptions are relatively common in the cervical spine; however, the spectrum of injury is large, and little is known regarding the magnitude of instability expected to be present in an isolated posterior osteoligamentous injury.

Purpose: To quantify the contribution of the posterior osteoligamentous structures to cervical spine stability during simulated flexion-extension (FE), lateral bend (LB), and axial rotation (AR).

Study Design: An in vitro biomechanical study.

Predicting the need for tracheostomy in patients with cervical spinal cord injury.

Background: Approximately 75% of hospitalized patients with a cervical spinal cord injury (CSCI) will require intubation and mechanical ventilation (MV) because of compromised respiratory function. It is difficult to predict those CSCI patients who will require prolonged ventilation and therefore will most benefit from early tracheostomy. This study intended to show the benefits of tracheostomy, particularly early, and to identify predictors of prolonged MV after CSCI.

Remote inflammatory response in liver is dependent on the segmental level of spinal cord injury.

Background: Traumatic spinal cord injury (SCI) triggers a systemic inflammatory response (SIR) that contributes to a high incidence of secondary organ complications, particularly after a cervical or high-level thoracic injury. Because liver plays a key role in initiating and propagating the SIR, the aim of this study was to assess the effects that SCI at differing segmental levels has on the intensity of the inflammatory response in the liver.

Methods: Using male Wistar rats, clip compression SCI was performed at the 4th thoracic (T4 SCI; high-level SCI) or the 12th thoracic (T12 SCI; low-level SCI) spinal cord segment.

The effect of soft-tissue restraints after type II odontoid fractures in the elderly: a biomechanical study.

Study Design: A biomechanical analysis of soft-tissue restraints to passive motion in odontoid fractures.

Objective: To quantify the role of the C1-C2 facet joint capsules and anterior longitudinal ligaments (ALLs) in the setting of a type II odontoid fracture in the elderly.

Summary Of Background Data: The odontoid process itself is the primary stabilizer at the C1-C2 level; however, little is known about the role of the soft-tissue structures that remain intact in the setting of an odontoid fracture after a low-energy mechanism.