A simple and effective method for directing the sagittal placement of thoracic pedicle screws without intraoperative imaging

Concurrent Session 5A: Adolescent Idiopathic Scoliosis & Complications. Paper no. 94postprintThe 17th International Meeting on Advanced Spine Techniques (IMAST 2010), Toronto, Canada, 21-24 July 2010

'Spring-back' closure associated with open-door cervical laminoplasty

BACKGROUND CONTEXT: Spring-back complication after open-door laminoplasty as described by Hirabayashi is a well-known risk, but its definition, incidence, and associated neurologic outcome remain unclear. OBJECTIVE: To investigate the incidence and the neurologic consequence of spring-back closure after open-door laminoplasty. STUDY DESIGN: A retrospective radiographic and clinical review. OUTCOME MEASURES: Lateral cervical spine X-rays were evaluated. Anteroposterior diameters (APD) of the vertebral canal of C3-C7 were measured. Spring-back was defined as loss of APD on follow-up in comparison to immediate postoperative canal expansion. The loss of the end-on lamina silhouette with consequent reappearance of the lateral profile of the spinous processes was also assessed to verify the presence of spring-back. Spring-back closure was classified based on whether the collapse was total or partial, and whether all the operated levels or only a subset had collapsed (ie, complete vs. partial closure, segmental closure vs. total-construct closure). Neurologic status was documented using the Japanese Orthopaedic Association (JOA) score. METHODS: Thirty consecutive patients who underwent open-door laminoplasty from 1995 to 2005 at a single institution with a minimum follow-up of 2 years were assessed. They were all operated on using the classic Hirabayashi technique. Radiographic outcomes were assessed independently by two individuals. RESULTS: Sixteen men and 14 women with an average follow-up of 5 years (range, 2-12 years) were included. Of these patients, 24 had cervical spondylotic myelopathy and six had ossification of the posterior longitudinal ligament. Spring-back closure was found in three patients (10%) and 7 of 117 laminae (6%) within 6 months of the operation, which was further confirmed by computed tomography and magnetic resonance imaging. All spring-back closures were partial segmental closures. Gender and age were not significant factors related to spring back (p>.05). The mean JOA score on follow-up was 12.5, with a recovery rate of 40%. All patients with spring back and available JOA data exhibited postoperative neurologic deterioration. Of the three patients with spring back, two patients underwent revision surgery, whereas one declined. CONCLUSIONS: Spring-back closure occurred in 10% of our patients at or before 6 months after surgery. The incidence of spring-back by level (ie, 117 laminae) was 6%, mainly occurring at the lower cervical spine. All spring-back closures were partial segmental closures, most commonly involving C5 and C6. Postoperative neurologic deficit was associated with spring-back closure; therefore, surgeons should adopt preemptive surgical measures to prevent the occurrence of such a complication.postprin

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Titanium mini-plates prevent springback closure in single-door cervical laminoplasty

Session - Free Papers Minimal Invasive Spine 1: abstract no. 41732INTRODUCTION: Springback closure after single-door cervical laminoplasty is a known and feared complication. It's incidence and consequence has been poorly defined, and various techniques have been used to prevent its occurrence. With technological advancement, we progressed from sutures, to Mitek anchors, to titanium mini-plates. The latter represented a viable alternative with other potential benefits. METHODS: Two cohorts of patients who underwent single-door cervical laminoplasty for spondylotic myelopathy and ossification of posterior longitudinal ligament were compared. One cohort, 30 patients, had laminoplasty hinges stabilized using traditional Hirabayashi suturing technique. The other cohort, 12 patients, had titanium mini-plates, with various patterns of plating ranging from plating at all levels to plating at 2 levels. Springback was defined as ≧ 4mm in -posterior diameter, and loss of end-on lamina silhouette and re-appearance of lateral profile of spinous process on lateral x-ray. Modified JOA score and recovery rates were the secondary outcome measures for this study. RESULTS: There were 3 patients in Hirabayashi group with springback closure. All were partial and segmental. For the latter group, there was no springback closure by our definition, though at levels without mini-plate a mild decrease in APD was noted in a few instances. Those with springback required revision surgery, but only had partial recovery. CONCLUSION: Springback closure represents a complication that can result in neurological deterioration and maybe revision surgery. Titanium mini-plates represents an excellent alternative to Hirabayashi technique with added benefit of potentially reducing axial neck pain & neck collar use due to its immediate stability