Browsing by keyword "Spondylosis"
Now showing items 1-2 of 2
-
Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degenerationSTUDY DESIGN: Retrospective radiographic analysis. OBJECTIVE: To retrospectively review a group of patients undergoing anterior cervical discectomy and fusion (ACDF) to determine the relative risk of adjacent level disc degeneration after incorrect needle localization. SUMMARY OF BACKGROUND DATA: The needle puncture technique is a well-established method to cause disc degeneration in experimental animal studies. The risk for accelerated degeneration because of needle puncture in humans is unknown. METHODS: A retrospective radiographic analysis of 87 consecutive patients after single or 2-level ACDF with anterior plate instrumentation was performed. Perioperative and follow-up radiographs were used to grade disc degeneration according to a previously described scale. RESULTS: Eighty-seven patients were included in the study (36 underwent 1-level ACDF, and 51 underwent 2-level ACDF). Seventy-two had correct needle localization at the level of planned surgery; 15 had incorrect needle localization (1 level above the operative level). There were no differences between the 2 groups in age, sex and length of follow-up. Patients in the incorrectly marked group were statistically more likely to demonstrate progressive disc degeneration with an odds ratio of 3.2. There was no correlation between age and length of follow-up with development of disc degeneration. CONCLUSION: There is a 3-fold increase in risk of developing adjacent level disc degeneration in incorrectly marked discs after ACDF at short-term follow-up. This may indicate that either needle related trauma or unnecessary surgical dissection contributes to accelerated adjacent segment degeneration.
-
Injury of an aberrant vertebral artery during a routine corpectomy: a case report and literature reviewCASE REPORT: A case report of a 58-year-old man who sustained a laceration of his left vertebral artery during a routine corpectomy for cervical myelopathy is reported. OBJECTIVE: To report iatrogenic injury of a tortuous vertebral artery during anterior cervical spine surgery and discuss appropriate diagnosis and treatment options for this complication. SETTING: UMass Memorial Medical Center, Worcester, MA, USA. BACKGROUND DATA: Vertebral artery anomalies, although rare, are typically present with degenerative processes and great care must be taken to avoid damage during a corpectomy. Cross-sectional imaging coupled with intraoperative angiography is helpful for the urgent evaluation of the injury site and identification of the contralateral vertebral artery's status. METHODS: This is a single case of a patient sustaining a laceration of the left vertebral artery during surgery, which resulted in a lateral medullary stroke. RESULTS: After the left vertebral artery laceration, hemostasis was achieved. With the intent to better visualize and possibly embolize or stent the injury, an angiographic study was carried out. The angiogram revealed a laceration of the left vertebral artery within the vertebral foramina at vertebral body level C6, but intact distal flow. The patient underwent angiographic embolization and a subsequent magnetic resonance imaging (MRI) revealed a left lateral medullary stroke consistent with the lack of flow through the left vertebral artery from C6 to the basilar artery. CONCLUSION: If a tortuous vertebral artery is suspected, then meticulous review of preoperative cross-sectional imaging should be implemented along with angiographic examination. If anomalies are detected and the standard procedure cannot be safely carried out, then alterations, such as preoperative stent placement, need to be considered.