Decompression and Interspinous Dynamic Stabilization Using the Locker for Lumbar Canal Stenosis Associated with Low-Grade Degenerative Spondylolisthesis.

Minim Invasive Neurosurg. 2010 Jun;53(3):117-121

Authors: Lee DY, Lee SH, Shim CS, Lee HY

BACKGROUND: Decompression and spinal fusion have been generally recommended for spinal stenosis associated with low-grade degenerative spondylolisthesis (DS), although this is still controversial. The purpose of the present study is to analyze the clinical and radiological outcomes of interspinous dynamic stabilization using the Locker (WINNOVA co, Seoul, Korea) for lumbar canal stenosis with grade I DS. METHODS: The authors performed a retrospective review of 23 consecutive patients who underwent single level decompression and the Locker application for lumbar canal stenosis with grade I DS and were followed up for at least 2 years. Excluded were those with DS grade II or higher and DS combined with foraminal disc herniation/stenosis. The mean age of patients at the time of surgery was 62.1 years (range: 45-81 years). RESULTS: There were no complications in the perioperative period. At a mean follow-up duration of 28.3 months (range: 24-32 months), visual analogue scale scores for back pain, leg pain, and Oswestry disability index had decreased significantly; from 4.6, 7.2, and 38.5% to 2.4, 2.6, and 15.3%, respectively. Clinical success was achieved in 87% of the patients. The mean percentage of slippage did not change significantly. The mean sagittal rotation angle significantly decreased from 9.7 to 6.5 degrees (p=0.01). One patient (4.3%) underwent secondary fusion surgery due to persistent pain. CONCLUSIONS: Decompression and interspinous dynamic stabilization using the Locker yielded favorable clinical and radiological outcomes for lumbar canal stenosis with grade I DS and could be an alternative for spinal fusion. However, further long-term follow-up studies are necessary.

PMID: 20809452 [PubMed - as supplied by publisher]

[Diagnosis and treatment of Paget disease of the spinal vertebrae]

Acta Chir Iugosl. 2010;57(1):49-55

Authors: Slavković SM, Vukasinović Z, Slavković NS, Apostolović MD

Paget disease, localized only on thoracic spine is extremly rare. It is a huge diagnostic problem and an equally big therapy challenge. Course of this disease is slow, it chronically worsens, thus demanding differentiation of various conditions, along with orthopaedic, neurological, radiographic and endocrine evaluation. Paget disease is followed by back pain, progressive weakening of legs and sphincter functions, due to pathological spine fractures and spinal stenosis. The treatment is surgical, in form of decompression and applying biphosphonates. Three patients are presented, all with worsening back pain which lasted several months. Hyperthonia and hyperreflexion of lower extremities were developed significantly. Over the course of time, neurological deficite got worse, almost to the point of spastic parapalegia. All of the patients were male, 50 to 68 years old. They had higher values of alcaline phosphatase and serum calcium than usual. In all cases, bone scintigraphy was positive where the lesion of thoracic spine existed. Biopsy suggested hyperparathyroidism, but, as it turned out, wrongly. After surgical treatment, neurological improvement was noticed on all three patients. In case of two, recidives occurred after three and five years respectively, so surgical reinterventions were made. These recidives are consequences of Paget disease progression. Aside from surgical treatment, they were treated by encrinologist. Remission of the disease lasted for seven and twelve years, respectively. Third patient had his condition recognized almost two years after first reception, and, due to big changes on vertebral body and paraplegia, posterior and anterior decompression of spinal canal and stabilization were done simultaneously. Biopsy confirmed Paget disease. During the postoperative course, nearly complete neurological improvement occured almost instantly. Only moments after hospital release, twenty four days after the operation, patient got sick in the hall. Unfortunately, he passed away due to massive lung embolism, even though he recieved adequate thromboembolic prophylaxion. Monoostotic form of Paget disease localized on vertebral body must be taken and considered seriously, especially when the patients suffer from progressive evolution of neurological deficite, followed by adequate biochemical blood and urine analysis, as well as radiographic signs of pathological fracture or invasive vertebral process. Surgical treatment can lead to significant improvement of clinical findings, but due to recidive, biphosphonate treatment is recommended.

PMID: 20681200 [PubMed - indexed for MEDLINE]