Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective review of 17 immature patients who underwent posterior spinal fusion of C1-C2 or C1-C3 was performed to establish the efficacy of the procedure, to determine the incidence of complications, and to identify those at high risk for complications. All had radiographic C1-C2 instability or dislocation. Etiologies included os odontoideum, fixed rotatory subluxation, atlantoaxial subluxation, type II dens fracture nonunion, and nonunion of a Hangman's fracture. Before surgery, 10 patients were neurologically intact, and seven had neurologic findings. Associated diagnosis included Down's syndrome in three and Ehler-Danhlos in one. Follow-up averaged 25 months. One neurologically intact patient had a C2 radiculopathy that resolved by 1 year. Three patients with Down's syndrome had complications: one with a preoperative Brown-Sequard syndrome had transient worsening in the immediate postoperative period, one with a preoperative myelopathy developed a late recurrence of a severe myelopathy that required odontectomy, and another sustained an intraoperative spinal cord contusion followed by postoperative quadriplegia and death due to respiratory failure. Of seven reporting neurologic symptoms before surgery, two had residual deficit in the late postoperative period. These two represented preventable technical errors. There were two nonunions, one of which required occiput to C2 fusion. In general, posterior spinal fusion of the upper cervical spine was found to be a reliable, safe, and predictable procedure, but extra caution should be employed when considering arthrodesis in patients with ongoing spinal cord compression, fixed dislocations, and inherited ligamentous laxity.
 ...
PMID:Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients. 183 26

Forty-five patients underwent surgical reconstruction with transpedicular fixation of the lumbar spine with narrow AO DCP plates. Preoperatively, all patients underwent spinal imaging with either magnetic resonance imaging, computed tomography, or myelogram as well as provocative discography to determine the location and the number of symptomatic segments. The minimum follow-up in this series was 2 years. The determination of solid posterior fusion in the presence of plate instrumentation was difficult. The patients in the series were classified as having 1) solid fusion; 2) radiographic flaws within the posterolateral fusion without implant failure; or 3) frank pseudarthrosis with implant failure. Thirty-six (80%) of the patients had a solid fusion, 9 of whom required an additional anterior interbody fusion to obtain symptom control. Twenty percent of the patients in the series had radiographic evidence of reabsorption without implant failure. Four patients in the series (8.8%) had screw breakage, three of which required anterior interbody fusions. The highest rate of reabsorption and pseudarthrosis implant failure was in the 12 patients who had three-level instrumentation; 33% of these patients required anterior interbody fusion to obtain a solid arthrodesis. The average preoperative pain scale was 8.9, and the average postoperative pain scale was a 3.3. Twenty-two patients in the series were cigarette smokers and had a slightly lower fusion rate than non-smokers. They did, however, have a higher use of narcotics after surgery. Forty percent of the patients in this series continued to have radiculopathy after their reconstruction. This study demonstrates the utility of transpedicular fixation in salvage lumbar surgery in obtaining a solid arthrodesis with a beneficial clinical result. Anterior interbody fusions are highly successful in the management of pseudarthrosis and implant failure after transpedicular instrumentation.
 ...
PMID:Reconstruction of failed lumbar surgery with narrow AO DCP plates for spinal arthrodesis. 202 35

Nineteen consecutive patients who had a symptomatic pseudarthrosis after a failed anterior cervical arthrodesis were treated by a posterior nerve-root decompression and arthrodesis. The indications for the operation were radiculopathy in the absence of myelopathy and evidence of a pseudarthrosis on lateral flexion and extension radiographs. The average duration of follow-up was forty-four months (range, twenty-four to fifty-four months). A solid fusion was achieved in all patients, and the radiculopathy was relieved in all but one. The motor weakness that had been present in four patients preoperatively resolved completely.
 ...
PMID:Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis. 239 87

Anterior fusion, laminectomy, and laminaplasty are recommended for the following conditions. For the treatment of one- or two-level spondylotic radiculopathy, anterior discectomy and fusion are preferred. For the treatment of spondylotic radiculopathy involving three or more levels, the open-door laminaplasty may be considered an alternative to anterior fusion. In this situation, laminaplasty is preferred for patients with developmental cervical canal stenosis, failed anterior fusion, or various prior anterior neck operations. Cervical laminectomy is indicated for patients with anterior bony ankylosis secondary to degenerative or inflammatory disorders and for patients in whom anterior fusion may be technically difficult, i.e., at C1-C3 or C7-T1. Anterior fusion is advisable for patients who have a structural reversal of the normal lordotic curve.
 ...
PMID:The surgical management of cervical spondylotic radiculopathy and myelopathy. 253 7

Twenty-two patients with spondylolisthesis were treated by closed reduction techniques with posterolateral arthrodesis. Ages ranged from 6 to 30 years, with an average of 18 years. Six patients were treated in skeletal traction. Postoperatively, two patients were immobilized in an ambulatory extension brace, 15 patients in a body cast incorporating one thigh, and five patients in a body cast incorporating Hoffman iliac pins and lumbar spinous process wires attached to an outrigger on the plaster. At an average of 40 months follow-up (range: 12-80 months), preoperative slip angle averaged 33 degrees, postreduction 12 degrees, and at follow-up, 11 degrees. The percent slip preoperative averaged 50%, postoperative 43%, and at follow-up, 40%. Complications included transient L5 radiculopathy in two patients treated in skeletal traction and loss of correction requiring anterior interbody fusion.
 ...
PMID:Closed reduction of spondylolisthesis. An experience in 22 patients. 318 3

Degenerative spondylolisthesis is the result of chronic disc degeneration with secondary segmental spinal instability. Localized collapse and translational and rotational vertebral subluxation result in low back pain and radiculopathy. Twenty patients with L4-5 degenerative spondylolisthesis having back pain and radiculopathy were treated with a combination of decompressive laminectomy and distraction arthrodesis with short parallel Harrington rods. Patients were ambulated immediately after operation. Minimum follow-up was 2 years (average, 31.6 months). Satisfactory results were obtained in 17 patients (85%). No intraoperative complications occurred. The spondylolisthesis progressed significantly in one patient and the Harrington rods loosened in another. The procedure appears to assist in reducing pathologic motion contributing to low back pain and to relieve traction or compression forces on neural structures by restoring spinal canal anatomy.
 ...
PMID:Decompression and distraction-derotation arthrodesis for degenerative spondylolisthesis. 371 26

We evaluated the results of the Robinson method of anterior cervical discectomy and arthrodesis with use of autogenous iliac-crest bone graft, at one to four levels, in 122 patients who had cervical radiculopathy. A one-level procedure was done in sixty-two of the 122 patients; a two-level procedure, in forty-eight; a three-level procedure, in eleven; and a four-level procedure, in one. The average duration of clinical and roentgenographic follow-up was six years (range, two to fifteen years). The average age was fifty years (range, twenty-five to seventy-eight years). Preoperatively, 118 patients had pain in the arm, fifty-five had weakness of one or more motor roots, and seventy-seven had sensory loss. At the time of follow-up, eighty-one patients had no pain in the neck, twenty-six had mild pain in the neck, nine had moderate pain in the neck, four had mild radicular pain, and two had a combination of mild radicular pain and moderate pain in the neck. One hundred and eight patients had no functional impairment, and fourteen had a slight limitation of function during the activities of daily living. Nine of eleven patients who had symptoms related to a change at one level cephalad or caudad to the site of a previous arthrodesis had another operative procedure. Lateral roentgenograms of the cervical spine, made in flexion and extension, showed a pseudarthrosis at twenty-four of 195 operatively treated segments. Sixteen of the patients who had a pseudarthrosis were symptomatic, but only four had sufficient pain to warrant revision. The risk of pseudarthrosis was significantly greater after a multiple-level arthrodesis than after a single-level arthrodesis (p < 0.01). At the time of the most recent follow-up, fifty-three of the fifty-five patients who had had a motor deficit had had a complete recovery, and the two remaining patients had had a partial recovery. Seventy-one of the seventy-seven patients who had had a sensory loss had regained sensation. None of the patients had an increased neurological deficit postoperatively. Our results suggest that the Robinson anterior cervical discectomy and arthrodesis with an autogenous iliac-crest bone graft for cervical radiculopathy is a safe procedure that can relieve pain and lead to resolution of neurological deficits in a high percentage of patients.
 ...
PMID:Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. 840 51

Thirty-five patients were managed operatively after failure of an anterior cervical discectomy and arthrodesis. Failure was classified as the absence of fusion without deformity but with neck pain or radiculopathy, or both; the absence of fusion after anterior or posterior dislodgment of the graft; or kyphosis due to collapse of the graft or to an unrecognized posterior soft-tissue injury. Twenty-three patients had failure of the arthrodesis without deformity (with neck pain only, neck and arm pain, radiculopathy, or myelopathy). Four patients had dislodgment of the graft; in two of them the graft migrated anteriorly after a multilevel Robinson arthrodesis, and in two it migrated posteriorly after a Cloward arthrodesis. Eight patients had a failure because of a kyphotic deformity. Five of them had had a Cloward arthrodesis; one, a discectomy; and two, a Robinson arthrodesis. Six had received allograft bone. Operative treatment of the pseudarthrosis consisted of repeat resection of the disc space in the area of the failed arthrodesis followed by repeat anterior Robinson arthrodesis with decompression of the nerve root if the patient had radiculopathy. It consisted of anterior corpectomy or vertebral-body resection and strut-grafting with reduction of the deformity if the patient had migration of the graft and kyphosis. The reoperations were performed four months to fourteen years (average, thirty-two months) after the initial operation. The duration of follow-up after the second operation averaged forty-four months (range, twenty-four to 216 months). The result was excellent for twenty-nine patients, good for one, fair for four, and poor for one. We concluded that, in patients who have persistent symptoms after an anterior cervical arthrodesis, an excellent result can be achieved with repeat anterior decompression and autogenous bone-grafting.
 ...
PMID:Failed anterior cervical discectomy and arthrodesis. Analysis and treatment of thirty-five patients. 911 96

Isthmic spondylolisthesis is a common condition and is frequently identified in the adult patient with low back pain. Although the natural history of this condition is not well defined, it is a common indication for nonoperative and operative treatment. The authors outline a systematic approach to the evaluation of the adult patient with isthmic spondylolisthesis. If radiologic studies are required, magnetic resonance imaging has improved the visualization of nerve-root compression in the neural foramen and is now widely used. Nonoperative treatment is the preferred approach in most symptomatic patients and is successful in as many as 60%. If nonoperative treatment fails, surgery may be recommended. Arthrodesis continues to be the mainstay of surgical treatment. Nerve-root decompression can be used in selected patients with radiculopathy. Although the Food and Drug Administration still considers the use of pedicle-screw instrumentation investigational or experimental, it has gained wide acceptance as an adjunct to fusion in the adult. It is important to note, however, that such use has not yet been proved safe and effective. Reduction of the spondylolisthetic segment has increased in acceptance for a small subset of patients with defined indications but carries a significant risk of complications.
 ...
PMID:Isthmic Spondylolisthesis in the Adult. 1079 55

After performing anterior cervical corpectomy or discectomy for cervical spondolytic myelopathy or radiculopathy, iliac crest bone graft and fibular auto- or allograft is often used to achieve arthrodesis in the cervical spine. The purpose of this study was to evaluate the use of a cylindrical titanium mesh and locking plate system as an alternative technique in achieving anterior cervical fusion and maintaining lordosis. Hospital records and radiographs of 38 patients who underwent anterior cervical discectomies (28 patients) or corpectomies (10 patients) from 1995 to 1997 were reviewed retrospectively. All patients had undergone arthrodesis in which autograft and a cylindrical titanium mesh and anterior locking plate fixation were used after discectomy or corpectomy. There were 20 men and 18 women (mean age 46.1 years; range 34-72 years). Presenting symptoms included radiculopathy (61%), myelopathy (37%), and neck pain (2%). Preoperative and postoperative radiographs were studied, and data were obtained on the following: overall lordosis or kyphosis of the cervical spine, segmental lordosis or kyphosis at each surgically treated level, and evidence of fusion. In all of the patients in whom lordosis was present preoperatively, lordosis was maintained during the follow-up period. The overall fusion rate was 100%. The average change in overall lordosis or kyphosis related to the fixation devices was 1.2 degrees (range 1-5 degrees) the average segmental change was 2.3 degrees (range 0-5 degrees); and the mean follow up was 16 months (range 12-36 months). Anterior cervical fusion with cylindrical titanium mesh and cervical locking plate system is an effective method of achieving arthrodesis and maintaining alignment in the cervical spine. The construct may provide additional load-sharing function, and it avoids the use of cadaveric bone or the need for harvesting tricortical iliac crest autograft.
 ...
PMID:Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. 1114 58


1 2 3 4 Next >>