Journal of Spine

Cervical radiculopathy frequently occurs secondary to degeneration of cervical disc and cervical spondylosis. The herniated disc material and the osteophytes compress the spinal cord and the nerve roots, resulting in clinical symptoms. Severe pain and neurological deficits often requires surgical intervention. Surgical management for radiculopathy of the cervical spine includes Anterior Cervical Discectomy with Fusion (ACDF), cervical foraminotomy via an anterior (ACF) or posterior approach, and Anterior Cervical Decompression and Arthroplasty (ACDA). Surgeons tend to choose the surgical method that is appropriate to the patient’s needs, the pathological characteristic of the case, and the surgeon’s skill.

Introduction: Expandable interbody spacers with adjustable lordosis were designed to expand in situ and avoid complications such as endplate damage, excessive trialing and forceful impaction associated with static spacers. This study compares the clinical and radiographic two-year outcomes between patients treated with static or expandable interbody spacers with adjustable lordosis for Minimally Invasive Lateral Lumbar Interbody Fusion (MIS LLIF).

Methods: This is a retrospective, multi-site, multi-surgeon, Institutional Review Board-exempt chart review of patients who underwent MIS LLIF using either a static (27 patients) or expandable spacer with adjustable lordosis (66 patients). Radiographs, complications and patient-reported outcomes were collected and compared from preoperative up to 24-month postoperative follow-up.

Results: Mean improvement of Visual Analogue Scale back pain at 6, 12 and 24 months, as well as Oswestry Disability Index scores at 3, 6, 12, and 24 months, were significantly higher in the expandable group compared to the static group. The mean improvement of ODI scores from preoperative to 3, 6, 12, and 24 months was significantly greater in the expandable group by 55.6%, 75.6%, 77.4%, and 108.9% and by 48.2%, 34.6%, and 71.5% at 6, 12, and 24 months postoperatively for VAS pain scores, compared to the static group and (p<0.05) Disc height mean improvement from preoperative to 24 months was more significant in the static group compared to the expandable group. Implant subsidence was significantly greater in the static group (18.5%, 5/27 patients) compared to the expandable group (0/66 patients) (all p<0.05).

Conclusion: This study showed significant positive clinical and radiographic outcomes for patients who underwent MIS LLIF using static or expandable interbody spacers with adjustable lordosis. Both static and expandable groups demonstrated long-term maintenance of significant radiographic improvements, with minimal complications reported and sustained significant clinical improvements at 24-month follow-up. There was a 0% subsidence rate in the expandable group, compared to an 18.5% subsidence rate in the static group. The use of expandable spacers with adjustable lordosis was safe and effective for the studied patient population.

Primary melanocytomas of the central nervous system are rare tumors arising from leptomeningeal melanocytes. Only 29 cases have been reported in the literature to date. Presenting symptoms may include insidious onset of back pain, slowly progressive neurological deficits such as weakness and sensory changes, in addition to bowel and bladder dysregulation. Advanced imaging including magnetic resonance imaging can be helpful in lesion localization but does not distinguish between primary and metastatic melanoma. In this case series, we present three patients with non-traumatic spinal cord injuries secondary to primary CNS malignant melanocytomas, who were admitted to a single inpatient rehabilitation facility within a 12-month time frame. These cases highlight the importance of the rehabilitation team in the continuum of care for patients undergoing resection of primary melanocytomas of the spinal cord. The rehabilitation team should be involved in the pre-operative counseling setting, immediately post-operatively and in follow up care. A comprehensive multidisciplinary approach including physical and occupational therapists, rehabilitation nurses, rehabilitation neuropsychologists and physiatrists is important for recovery of these patients.

Objective: The purpose of this study is to find out the current trends and its effects in locomotor rehabilitation of individuals with incomplete spinal cord.

Methods: Articles were searched through PubMed and Google scholar (year 2016-2020) written in English literature was performed regarding recent advances in the rehabilitation technologies of incomplete SCI patients.

Results: Results of this research were according to the based on the clinical findings: Exoskeleton-assisted Gait Training (EGT), Virtual Reality (VR), Robot-Assisted Locomotor Training (RALT), Home based Virtual Reality, Dynamic weight shifting into treadmill, are currently being used.

Conclusion: As per the study, there has been advancement in rehabilitation technologies and a significant improvement was noticed in incomplete spinal cord injury patients. More clinical trials and further study is needed for better improvement.

Background: Surgical intervention may become necessary for chronic pain secondary to Lumbar Spinal Stenosis (LSS). It can be effectively achieved by using Conventional Decompression Surgery (CDS) or Minimally Invasive Spine Surgery (MISS). This study aimed to compare the functional outcome and complications associated with these two techniques.

Methods: Online database sources (PMC and Cochrane Library) were utilized to identify 1,050 publications, which were narrowed down to 18 studies included in this systematic review. The mean postoperative improvement in Oswestry Disability Index (ODI) and Visual Analog Scale/ Numeric Pain Rating Scale (VAS/NPRS) scores was statistically evaluated by using SPSS-23 and compared for the two techniques through independent t-test. A p-value <0.05 was considered significant.

Results: A total of 1,724 patients [CDS=705; MISS=1019] were included in the study. MISS cases had a significantly greater mean ODI preoperatively and the mean ODI improvement was significantly better in this cohort. The patients undergoing MISS also had a significant decline in the VAS/NPRS scores for Low Back Pain (LBP) and Leg Pain (LP). A significantly higher rate of operative complications and reoperation were seen in CDS patients.

Conclusion: In cases of LSS, this review suggests that MISS carries a lower risk of complications and appears to yield better functional outcomes when compared to CDS.