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Landmark Papes in Neurosurgery > Spine > Flashcards

Spine Flashcards

1
Q

SPORT Bandscheibe Weinstein

A

ca. 2000 Patienten
primary outcome: 36-item Short-form healthy survery, modified ODI
no effect in intent-to-treat analysis
favourable effect in as-treated analysis
30-50% changed into surgical group
significant advantages in self-reported progress

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2
Q

SPORT Spinalkanalstenose ohne Spondylolisthese

A

favours surgery in primary and secondary outcomes

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3
Q

SPORT Degenerative Spondylolisthese mit Spinalkanalstenose

A

Level II evidence favours surgery

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4
Q

Peul The Leiden_The Hague Spine Intervention Prognostic Study

A

Bandscheibenvorfall
OP = konservativ

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5
Q

Thome 2005

A

Sequestrektomie = Disektomie
Sequestrektomie was introduced by Wiliams
Re-herniation rates ca. 10%
LBP in disectomy patients

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6
Q

Bandscheibenprothese/Prestige
Burkus_2014

A

Kontraindikationen:
- signifikante Spondylarthrose
- Ossifikation des Lig. longitudinale
- Bridging osteophytes
- segmentaler Höhenverlust > 50%
- Kyphotische Deformität
- Hypo- und Hypermobilität (> 3.5 mm sagittal, > 20° sagittal)
- Osteopenie/Osteoporose
- Nicht-degenerative Pathologien: Tumoren, Infektionen, Trauma

Burkus:
- NDI Prestige sligthly better as ACDF
- angular motion is preserved
- Re-operations due to ASD at 5 years same, at 7 years ACDF more

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7
Q

Frykholm

A

indication:
- unilateral soft disc herniation with more than 2/3 of the disc herniation lateral to the spinal cord
- medial body foraminal stenosis

withdrawals:
- potential instability
- neck pain 20%
- worse outcomes in bony foraminal stenosis
- higher reoperation rates compared to ACDF

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8
Q

Postnukleotomiesyndrom

A

postop MRT:
- 60 Rezessusstenose
- 10% SKS
- 10% Rezidivvorfall
- 10% Arachnoiditis
- 10% epidurale Fibrosierung (keine Ursache für Radikulopathie)

Pathologie:
- 10% segmentale Instabilität (FG-Syndrom)
- Rezidivvorfall –> PRT als Diagnostik 1. Wahl

Bartouhi_2013: Auffälligkeiten in postop MRT kann nicht unterscheiden zwischen “Symptomatischen” und “Asymptomatischen”

Klare Indikation für OP: Diszitis, Liquorleck, Rezidiv-Vorfall

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9
Q

SCS

A
  • Ischialgie ohne strukturelle Ursache
  • 60% Schmerzreduktion
  • in bis zu 40% d.F. Implantat-assoziierte Komplikationen
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10
Q

Lumbale Bandscheibenprothese

A

Bandscheibenerkrankung ohne Facettengelenksarthrose
Anschlussdegeneration bei Prothese 9% (Fusion 30%)

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11
Q

Juch_2017 Mint randomized clinical trial

A

Radiofrequenztherapie: keine signifikante Verbesserung nach 3 und 12 Monaten

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12
Q

Spine stabilisation trial Fairbank 2005

A

fusion vs intensive rehabilitation
only marginal but significant better outcomes for surgery

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13
Q

Försth_2016
SSSS Swedish Spinal Stenosis Study

A

SKS +/- Spondylolisthese
24 vs 27 Patienten
Fusion = Dekompression
Re-OP: 22% Fusion = Dekompression

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14
Q

Ghogawala_2016
SLIP Trial Spinal Laminectomy vs Instrumented Pedicle Screws

A

Grad 1 Spondylolisthese mit SKS
Fusion leicht besser als Laminektomie

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15
Q

Fehlings_Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)

A

24 h Grenze
24 h 2.8 Odds Ratio for improvement >= 2 ASIA grades
complication rate 22% early surgery vs 30% late surgery

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16
Q

NASCIS National Acute Spinal Cord Injury Study

A

I: Methylprednisolon 100 mg = 1000 mg
II: Methylprednisolon > Placebo
III: 24 h Prednisolon, wenn < 3 h /// 48 h Prednisolon, wenn 3-8 h

17
Q

Bernard_2015 Diszitis

A

6 Wochen = 12 Wochen
orale Therapie

18
Q

CAFE (cancer patient fracture evaluation) Berenson_2011

A

Ballonkyphoplastie > konservativ
osteolytische Frakturen, VAS >4/10

19
Q

NORDSTEN-Trial (Austenvoll 2021)

A

ILF = bilateral ILF = Laminektomie
Fusion = Dekompression bei SKS mit Spondylolisthese

20
Q

Thome 2022

A

KG <= 3, OP innerhalb 3 d
KG = 4, OP innerhalb 8 h

21
Q

MeyerB_2017 interspinous process devices (IPDs)

A

IPD = Dekompression für selektierte Patienten (typische neurogene Claudicatio mit Besserung bei Flexion)
20% Revisionsrate bei ausbleibendem Erfolg

22
Q

ACDF nach Cloward

A

Risikofaktoren für eine klinische Verschlechterung der Myelopathie:
- erhöhte Segmentmobilität
- segmentale Kyphose
- Olisthese
- trianguläre Verformung des Myelons

Komplikationen:
7% Heiserkeit
bis 70% Dysphagie
5% Pseudarthrose
2.5% C5-Parese
ASD 3%/Jahr (Re-Op in 10% 7.5%)

23
Q

Patchell_2005

A

preliminary stopped study because of
decompression + konventionelle RTX > konventionelle RTX
ability to walk

24
Q

Bilsky_2014

A

SRS (stereotactic radiosurgery) + “separation surgery” is effective and safe

25
Q

Dohm_2014
KAVIAR = Kyphoplasty and Vertebroplasty In the Augmentation
and Restoration of vertebral body compression fractures

A

erste RCT
Kyphoplastie > Vertebroplastie&raquo_space;> konservativ
(Re-Fraktur, Zementleckage, Kyphosekorrektur)

26
Q

NEXUS-Kriterien
1998

A

Fehlender Druckschmerz über der Mittellinie der HWS
Kein fokales neurologisches Defizit
Normale Vigilanz (GCS 15)
Kein Hinweis auf Intoxikation
Keine weitere schwere Verletzung

27
Q

TLICS

A

morphology: compression, burst, translation/rotation, distraction (immediate stability)
integrity of PLC (posterior ligamentous complex, longterm stability): intact, suspected, injured
neurological status: intact, nerve root, complete cord, cauda equina

predicts surgery: > 4 surgical

28
Q

CTA in HWS-Trauma

A

Vertebralisverletzung in 20%, v.a. bei Facetten#, Foramen transversum#, ankylosierenden Erkrankungen

29
Q

Hilibrand 1997 ASD

A

3%/jahr bei ACDF, nach 10 Jahren 25%
nur 12-20% symptomatisch, requires Re-Op

30
Q

Ibrahim_2007

A

Spinal osseus metastasis
surgery > konservativ

31
Q

Modified Japanese Orthopaedic Association scale (mJOA)

A

upper extermity - motor skills (max. 5)
upper extremity - sensory dysfunktion (max. 3)
loqer extremity - motor skills (max. 7)
urination (max 3).

cut-off 12 for severe myelopathy

Landmark Papes in Neurosurgery (5 decks)

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