• WAVES OF CELLULAR APOPTOSIS IN MODERATE SPINAL CORD INJURY (SCI) IN THE RAT

    Cell loss following SCI is greater than expected given the severity of injury. This secondary cell death is apoptotic, having many of the features of programmed cell death (PCD) that occurs during development. In an effort to approach the extensive long tract demyelination that occurs chronically after SCI, focus by several groups has been on delayed, up to 14 days, PCD in oligodendrocyte populations, occurring at a distance from the lesion epicenter after controlled contusion SCI. In contrast, we have reported that after severe (50 gm·cm force) SCI, apoptosis occurred in 4 distinct cellular compartments, including neuronal, and even motoneuronal cells, with peak PCD in 3 of these compartments at day 3 after injury.
  • INCREASED FUSION RATES WITH CERVICAL PLATING FOR TWO-LEVEL ACDF

    INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) has a high fusion rate, however, the pseudarthrosis rate increases with two-level surgeries. The use of cervical plating can provide increased stability and may allow for better healing and subsequent fusion. The purpose of this study was to compare the results of two-level ACDF in a large group of patients with and without cervical plating. METHODS: 60 consecutive patients having two-level anterior cervical discectomy and fusion by the senior author between 1990-1996 were entered into the study.
  • THE RELATIONSHIP BETWEEN DISC DEGENERATION AND MORPHOLOGIC CHANGES IN THE INTERVERTEBRAL FORAMEN OF THE CERVICAL SPINE: A CADAVERIC MRI AND CT STUDY.

    INTRODUCTION: The pathogenesis of cervical spondylosis involves degenerative changes in the intervertebral disc and subsequent morphologic changes in the zygapophyseal joints and intervertebral foramen. Nerve root compression in the intervertebral foramen is a frequent sequela of cervical spondylosis. The purpose of this study is to investigate the relationship between disc degeneration and morphologic changes in the intervertebral foramen, including the effect on the nerve root. MATERIALS AND METHODS: Seven fresh frozen human cadavers were dissected from C1 to T1, preserving the ligaments, capsules, intervertebral disc, and the neural structures.
  • RADIATION EXPOSURE USING INTRAOPERATIVE FLUOROSCOPY FOR ANTERIOR CERVICAL DISKECTOMY AND FUSION

    INTRODUCTION: The use of intraoperative fluoroscopy, in place of standard radiographs in anterior cervical decompression and fusion surgery, has received little attention and appears to be used by a minority of surgeons on a consistent basis. Identification of the appropriate level is not only necessary for a positive outcome, but is the standard of care. From personal experience, I found that the use of intraoperative fluoroscopy increased surgeon confidence and reduced operating room time. I undertook this study in an effort to determine the risks of radiation exposure using fluoroscopy to the operating surgeon and the surgical team, as well as its impact on efficiency, cost, and surgeon confidence.
  • RADIOGRAPHIC COMPARISON OF PLATED VERSUS UNPLATED FUSIONS FOR SINGLE ACDF

    INTRODUCTION: The use of plates in single level anterior discectomy and fusion has been the source of ongoing debate. The success rates of unplated single level fusions is quite high and many advocate this as the procedure of choice. The use of a plate is thought to improve stability at the fusion site and increase fusion rates, allow earlier mobilization, and may help prevent graft extrusion and collapse. This study is a review of the elective single level primary ACDF’s performed by the senior author. From 1990 to 1994 unplated ACDF was performed, and routine plating was used from 1994 to 1997. The purpose of the study is to determine if there is a difference in fusion rates and final alignment between plated and unplated fusions.
  • COMPLICATIONS OF BUTTRESS PLATE STABILIZATION OF CERVICAL CORPECTOMIES.

    INTRODUCTION: Graft extrusion is a well-recognized complication of multi-level cervical corpectomies and strut grafting. In an attempt to decrease this complication, a number of authors have employed anterior cervical plates. One recently reported technique involves the use of short buttress plates which are fixed to the inferior most vertebrae only. In the present study, we report our experience with these types of buttress plates with a focus on their complications. METHODS: The records and radiographs of all patients who had undergone cervical buttress plate fixation following anterior cervical corpectomy from August 1995 to the present, by the lead author, were independently evaluated by two residents uninvolved in the patients’ clinical management. A total of 14 patients were identified: ten female, four males; age range 29 to 82.
  • NECK AND SHOULDER PAIN AFTER MUSCLE-PEDICLED SPINOUS PROCESS RECONSTRUCTIVE OPEN DOOR LAMINOPLASTY: RELATION TO POSTOPERATIVE IMMOBILIZATION PERIOD

    INTRODUCTION: Postoperative nape pain is not an unusual or major complication of surgery, but many surgeons report that patients suffer from it. In 1994, the authors presented that the postoperative ROM of the cervical spine correlated to postoperative nape pain. The authors hypothesized that shortening the postoperative immobilization period would increase the postoperative cervical ROM and decrease postoperative nape pain. Since 1994, we have shortened the postoperative immobilization period from 12 weeks to 6 weeks. The purpose of this study was to compare postoperative nape pain, ROM, and clinical results in a 12 weeks-postoperative group and a 6 weeks-postoperative group, thereby to examine our hypothesis.
  • SINGLE-LEVEL ANTERIOR CERVICAL DISCECTOMY: PLATE VS NO PLATE

    INTRODUCTION: Cervical plate fixation for single-level anterior cervical discectomy and fusion (ACDF) has generated a large amount of controversy. Proponents of plate fixation argue that there is increased stability, higher fusion rates, and less collapse and resulting deformity. Others argue that the plate can prevent settling of the graft and lead to lower fusion rates and more complications. The purpose of this study was to compare a large group of patients undergoing single-level anterior cervical discectomy and fusion with and without plate fixation and determine the pseudarthrosis rates, amount of collapse, and the complication rates.