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Use of navigation-assisted luoroscopy to decrease radiation exposure during minimally invasive spine surgery thyroid cancer t shirts purchase 200 mcg levothroid free shipping. Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Today, a variety of different instrumentation systems may be used in posterior-based minimally invasive lumbar spine surgery. Each type of instrumentation has been shown to be safely and efectively used in minimally invasive surgery. Indications and Contraindications he indications for minimally invasive posterior spinal instrumentation are similar to traditional open surgery. Minimally invasive posterior spinal fusion with instrumentation has been used safely and efectively to treat instability associated with spondylolisthesis, degenerative disc disease, large or recurrent disc herniations, postlaminectomy instability, degenerative scoliosis, and trauma. Minimally invasive fusion with instrumentation can be performed safely in the revision setting and is oten advantageous, as it allows the surgeon to access the spine through a native surgical corridor free of scar tissue. A number of high-quality studies have shown the harmful efect of open exposure related to muscle detachment, ligamentous disruption, denervation, adjacent facet joint disruption, and prolonged muscle retraction. In all, these events can lead to increased risk of local instability and adjacent-level disease, requiring further surgery. However, with experience, obesity becomes a relative indication for minimally invasive fusion and instrumentation rather than a contraindication, as tubular retractors and percutaneous techniques drastically minimize surgical exposure in obese patients where adipose tissue and the deep (oten thick) musculature make traditional open techniques diicult. Our personal experience has found that pedicle screws oten can be placed more easily through a minimally invasive Wiltse-type approach as compared with midline approaches because there is much less muscle, fat, and sot tissue retraction necessary to obtain the correct screw trajectory. Minimally invasive lumbar surgery in obese patients also creates less postoperative dead space, which may lead to lower infection rates. Two patients developed supericial cellulitis ater minimally invasive fusions and one patient developed discitis ater a microendoscopic discectomy. Technical Outcomes of Transpedicular Lumbar Instrumentation he goal of lumbar instrumentation is to provide stability required to improve the rate of spinal fusion. Pedicle screws engage all three anatomic columns of the vertebra as deined by Denis. Overall, they concluded that with attention to technical details of the operative technique, there were few complications with use of pedicle screws. Screws can be placed using a variety of methods-including freehand, under C-arm guidance, or using navigation-depending on surgeon preference. In addition, both posted- and tulip-style screws can be used if working through the tubular retractor systems that are available.
Passive physical therapy modalities such as ice thyroid gland location buy levothroid 200 mcg with mastercard, massage, or heat can be helpful in initial treatment, but the athlete needs to begin active rehabilitation and assume responsibility for his or her recovery. A gymnast with spondylolysis needs a program avoiding hyperextension while the bone is allowed to heal. As rehabilitation goals, the gymnast needs to stay active in the maneuvers that do not stress the back and to maintain general itness. Generally, rehabilitation begins with lexion and extension cycles to reduce joint stifness and relax elastic structures. Focus is irst placed on the anterior abdominal muscles and maintaining the spine in neutral position, followed by lateral muscle exercises for side support of quadratus lumborum and abdominal wall muscles; inally, an extensor muscle program is added. Core Stabilization A core stabilization program is based on the principle of coordinated muscle contraction. Finding and maintaining a pain-free position is fundamental to reestablishing isometric muscle control. Flexibility Bracing Bracing may be efective if used intermittently and primarily as a tool for returning to activity. Lumbar function assessed by self-reported and objective measures does not seem to worsen with shortterm use of nonrigid, inelastic bracing for low back pain. Programs emphasizing trunk stabilization with a neutral spine have had the most success. Muscle Performance (Strength Versus Endurance) he term strength is deined as the maximum force that a muscle can produce during a single exertion to create joint torque. Current thought remains disparate, however, regarding the therapeutic value of traction. Rehabilitation he rehabilitation program consists of stages that encourages building a foundation of fundamentals and moving through increasingly diicult levels of activity. Physical rehabilitation should be designed to be sport speciic and diagnosis speciic. Deep Water Running and Swimming Walking in a swimming pool is a gentle strengthening exercise for the back. Deep water running is excellent for Chapter 33 the Immature Spine and Athletic Injuries 593 treating athletes with back pain. Athletes run in the deep end of a swimming pool, normally with the aid of a lotation vest. Water is about 800 times denser than air; thus, resistance met during water running is greater than when running on land. Deep water running can help to maintain aerobic performance for 6 weeks in trained endurance athletes; sedentary individuals can appreciate signiicantly increased maximal oxygen uptake. During spine rehabilitation programs, deep water running can be used for maintenance training, but deep water running is not a substitute for conventional training. Education Several studies have documented the value of patient education in the treatment of spine problems.
Excision of the rib head and herniated disc provides access to the spinal canal thyroid gland operation video dailymotion purchase 100 mcg levothroid mastercard, which allows clear visualization to ensure adequate decompression. A systematic review of 12 articles reported complete resolution of symptoms in 79% of the patients and improvement but with residual symptoms in 10. Excluding inappropriate cases such as pleural adhesions and severe kyphotic instability, the minimally invasive anterior approach to treat spinal tuberculosis has shown promising results in many institutions if performed by experienced thoracoscopic surgeons. It is currently used in a wide spectrum of therapeutic indications, including spinal deformities, thoracic disc herniation, spinal tumors, infections, and other pathologic processes if the lesion position is amenable to an anterolateral approach. Gradual correction of a scoliotic deformity has been achieved with anterior vertebral growth modulation using a 4. Infection Spinal tuberculosis (Pott disease), accounting for 50% of the cases of extrapulmonary involvement, still remains a major health issue in both developed and developing countries. She underwent spinal growth modulation surgery through anterior thoracoscopic instrumentation, then was tethered by a polyethylene lexible cord. Positioning of the patient is crucial; otherwise, the surgeon may be misled about spinal orientation and misplace instrumentation. Portal placement should be optimized to facilitate the working range of the surgical instruments. Adequate visualization can be obtained by complete lung delation and meticulous hemostasis. Surgeons should master anterior released discectomy and fusion before attempting to use fully endoscopic anterior instrumentation. Loss of perspective or orientation within the chest can be avoided by looking through the portal directly. A mini-open approach should be a back-up plan to ensure safe completion of the procedure. Pseudarthrosis can be avoided by performing a thorough discectomy and endplate excision. Although performed through relatively small incisions, thoracoscopic surgeons must have substantial experience to perform similar procedures via a mini-open approach in properly selected cases. Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw ixation Juvenile idiopathic scoliosis treated with posterior arthrodesis and segmental pedicle screw instrumentation before the age of 9 years: a 5-year follow-up. Preventing the crankshat phenomenon by combining anterior fusion with posterior instrumentation: does it work Deining the pediatric spinal thoracoscopy learning curve: sixty-ive consecutive cases. A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes ater early spinal fusion.
Iohexol (Omnipaque 240) is then injected under live luoroscopy to conirm contrast spread medially around the pedicle thyroid cancer metastasis to lung symptoms levothroid 200 mcg purchase online, and inferiolaterally along the exiting spinal nerve, without vascular runof. Only 12 of these cases were detected with contrast injection under standard luoroscopy. In a rat study of four diferent steroid preparations (both soluble and nonsoluble), dexamethasone was the only one that did not result in serious neurologic injury ater carotid artery injection. Pain from the cervical facet joints has been reported to account for between 36% and 67% of patients with chronic neck pain. Unlike in the lumbar region, there is limited literature on the use of intraarticular steroid injections into the cervical facet joints. Only one randomized trial exists that compared intraarticular Chapter 22 Anatomy, Nonoperative Results, Preoperative Injections, and Prescriptions 387 injection of steroid to local anesthetic. Two observational studies of cervical facet intraarticular steroid injections showed short-term beneit. Aspiration of each needle must be negative for blood, cerebrospinal luid, or paresthesia prior to injection. Axial sensory perception threshold using 50-Hz sensory stimulation is achieved at 0. If steroid is mixed with the bupivacaine, it is recommended that dexamethasone be used for reasons described earlier under the risk of intraarterial injection of particulate steroid. While lumbar decompression is considered the gold standard therapy for lumbar spinal stenosis, not all patients are acceptable surgical candidates. However, this study has been criticized for using relatively low volumes of injectate, inclusion of patients with acute low back pain, and the injection of an active drug, lidocaine, as an inactive control. However, both the lidocaine and steroid groups had substantial percentages (nearly 50%) of subjects achieving more than 30% relief of leg pain compared to baseline and 38% in both groups reported more than 50% relief of leg pain. In a meta-analysis of epidural steroid injections compared to epidural injections of nonsteroid solutions and injections of solutions outside of the epidural space, Bicket et al. Procedure: Lumbar Interlaminar Epidural Steroid Injection For this procedure, the patient is placed in a prone position. A pointer is then placed over the superior edge of the lamina of the inferior vertebral level of the target, at the ipsilateral side of the pain for a paramedian approach. At this stage, a contralateral oblique 50-degree C-arm view is recommended to watch needle depth. When using a paramedian approach, a lateral view is not appropriate, as it will not give an adequate view of needle depth just below the ipsilateral lamina. If using a midline approach, a lateral view is appropriate to monitor needle depth. Procedure: Caudal Epidural Steroid Injection he patient is placed in a prone position with a pillow under the abdomen, and the legs slightly abducted with internal rotation. A pointer is placed over the sacral hiatus at around a 45-degree angle using a lateral luoroscopic projection to assist in identifying the sacral hiatus. In his review of these blocks, Datta45 found moderate evidence for the eicacy of selective nerve blocks as a diagnostic tool in radicular pain.
Radiographic followup is recommended at least annually until skeletal maturity and more frequently during peak height velocity before puberty thyroid cancer lawsuit safe 100 mcg levothroid. Documentation of slip percentage, angle, sacral inclination, wedging, and pelvic tilt is recommended as part of proper documentation of progression of the deformity. Surgical Treatment Surgical intervention is indicated for patients with persistent pain, progressive spondylolisthesis, or neurologic symptoms who fail conservative management. In contrast to a comparable adult, an asymptomatic adolescent may be a candidate for surgical intervention because of expected progression of deformity in a high-grade slip, which may lead to mechanical and neurologic dysfunction. In a skeletally immature patient with slippage greater than 50% or a mature adolescent with a slip greater than 75%, operative intervention is recommended even if the patient is asymptomatic. Procedures for direct ixation of pars defects include the Buck technique,117 Scott wiring,118 and repair with an ipsilateral pedicle screw and hook. Kinematic studies of adjacent vertebra ater fusion have shown disc degeneration, increased stress at the facet joints, hypertrophy of the facets, and hypermobility at the adjacent level. Fusion is an option if an attempt at pars repair is unsuccessful, the lamina is dysplastic, the defect is very large, or disc degeneration or listhesis is present. Some authors maintain that results for fusion are better at L5 because of the narrow lamina at L5 and the steep lordotic angle that may be present. In their series of 100 patients who had failed conservative management, the pain generator was conirmed by injecting 1. Reproduction of similar pain and pain relief of at least 70% of the usual pain quality for more than 6 hours were considered as a positive response; these patients subsequently showed an excellent outcome ater repair of the defect. Various studies showed 88% to 100% defect healing and satisfactory results with his technique. Bradford and Iza134 reported 80% good to excellent results and 90% radiographic healing of the defects. Salib and Pettine135 modiied this technique by passing a wire around the cortical screws introduced into both pedicles and tightening it beneath the spinous process. Biomechanical tests show that ixation of the wire to the pedicle screw does not increase the stifness of the system. Morscher and colleagues140 introduced a new technique to repair the pars defect with a laminar hook, which is loaded with compression by a spring placed against a screw threaded in the articular process. Taddonio, using the Cotrel-Dubousset system, irst introduced a repair using pedicle screw ixation. Kakiuchi147 reported similar results using the Texas Scottish Rite Hospital instrumentation system; with this technique, hooks are ixed at the lamina and connected with a rod to an ipsilateral pedicle screw ater compression. Roca and colleagues148 reported 92% excellent results with their new pedicle screw hook construct system in adolescents, but they have not recommended this technique for patients older than 20 years. Pellise and colleagues149 advised 1-mm thin cuts to assess the pars anatomy, but 2.
Syndromes
Neoplasia of the spine may originate in either the neural or the osseous elements thyroid gland negative feedback cheap 200 mcg levothroid with mastercard. Osteoid osteoma is a small, sclerotic, irritative lesion of the posterior spinal elements. Although the natural history is for spontaneous resolution of the pain over years, patients do not oten tolerate long-term pain well. Osteoid osteoma and osteoblastoma may manifest as stifness or scoliosis with or without pain. Bone scan is intensely positive and an excellent irst supplemental imaging study in children. Eosinophilic granuloma in the spine produces a lattening of the vertebra, or vertebra plana, rarely with neurologic compromise. Bony malignancies are rare and include leukemia, Ewing sarcoma, and osteosarcoma in bone, and neuroblastoma or astrocytoma in the spinal cord. In the absence of actual bone destruction, these tumors may show subtle signs of pressure owing to their growth, such as separation or thinning of the pedicles or scoliosis. Spinal cord tumors, such as astrocytoma or ependymoma, are more likely to manifest as extremity weakness, gait disturbance, or scoliosis. Precisely because they are rare, these serious lesions should always be kept in mind. Back pain in an active adolescent athlete is due to spondylolysis until proven otherwise. An open-ended history taken from the patient is the most cost-efective diagnostic tool and worth the time. Do not perform a cursory nonfocused history and examination for adolescent back pain. Do not jump to surgery before implementing efective nonoperative treatment for back pain. Tumor did not show on magnetic resonance imaging done for this 14-year-old softball pitcher who presented with back pain and scoliosis. The risk of reporting recurrent low back pain up to age 23 years was 16 times as high in the group with early degenerative disc indings. The authors based their review on more than 125 articles addressing spondylolysis. Their conclusions were that isthmic spondylolysis is a fatigue fracture of the pars interarticularis, which is more often symptomatic in adolescent athletes.
Solute transport decreased 45% across nerve root segments with the low pressure of 10 mm Hg thyroid cancer untreated prognosis purchase levothroid 200 mcg on-line. In addition to neural compression and altered nutrition, inlammatory chemical mediators have also been shown to be a cause of pain. What causes pain in some individuals with mild spinal stenosis and no symptoms in others with severe stenosis Because the magnitude an individual can compensate for is diferent for diferent people, two individuals with the same amount of stenosis may not exhibit the same symptoms. Individuals may become symptomatic with a lower magnitude of compression if it occurs rapidly. As one would expect, congenital stenosis becomes symptomatic much earlier in life and patients usually become symptomatic in the fourth decade. Acquired stenosis can be caused by trauma, neoplasms, and infection, along with other causes listed in Box 61. Deformity and Instability he static changes discussed thus far can be worsened by dynamic factors such as segmental instability. Instability typically arises from degenerative changes and can be in the form of translational or rotational abnormality. Translational abnormality is found most commonly in women as a degenerative anterolisthesis of L4 on L5. Foraminal stenosis can also occur in this setting, with collapse of the disc space, disc herniation, endplate osteophytes, or facet hypertrophy. With scoliosis, lateral subluxation and rotational instability can cause altered biomechanics that accelerate further degeneration. Degenerative changes Natural History Patients with congenital stenosis typically become symptomatic earlier in life. Due to congenital narrowing of the canal in these patients, signiicant stenosis is present at multiple levels even with little degenerative change. A separate retrospective study of asymptomatic lumbar stenosis attempted to answer this question. A group of 41 patients with cervical myelopathy who had asymptomatic lumbar stenosis and a mean age of 69 years were followed. Multiple studies have looked at the short-term and longterm results of nonoperative treatment of patients with symptomatic lumbar stenosis. Johnsson and colleagues reviewed the results of 32 patients who declined to have surgery at a 4-year follow-up period. Recently, prospective studies have reported short-term and long-term results of nonoperative and operative treatment. Miyamoto and colleagues reported prospective results of nonsurgical treatment in 120 patients.
The results of this analysis support the conclusions reached by Herkowitz and his group: patients do better with decompression in conjunction with fusion thyroid palpation levothroid 100 mcg buy overnight delivery, and instrumentation enhances the fusion rate. This prospective, randomized controlled study compared laminectomy alone to laminectomy and instrumented posterolateral fusion in 66 patients with degenerative spondylolisthesis and stenosis. The most striking diference between treatments was the reoperation rate, which was 14% in the fusion group and 34% in the laminectomy alone group. Another prospective, randomized controlled study, reporting no diference between decompression alone versus decompression and fusion in patients with degenerative spondylolisthesis and stenosis. Spondylolisthesis with an intact neural arch: the so-called pseudo-spondylolisthesis. This classic article by Ian Macnab describes the etiology, clinical indings, and treatment of degenerative spondylolisthesis. Another classic article that describes the etiology, biomechanics, and mechanism of slipping in spondylolisthesis. This classic, prospective, randomized, controlled study showed that decompression and noninstrumented fusion was superior to decompression alone in the treatment of degenerative spondylolisthesis. This prospective, randomized study compared posterior pedicle screw ixation with noninstrumented posterolateral fusion and found that the fusion rate at 2 years was better in the instrumented group than in the noninstrumented group, although the clinical outcome was similar in both. Spondylolisthesis: classiication of spondylolisthesis as a guideline for treatment. Degenerative lumbosacral spondylolisthesis: possible factors which predispose the ith lumbar vertebra to slip. Expression of estrogen receptor of the facet joints in degenerative spondylolisthesis. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Hypertrophied ligamentum lavum in lumbar spinal canal stenosis: pathogenesis and morphologic and immunohistochemical observation. Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging. Lumbosacral segmental motion in normal individuals: have we been measuring instability properly Roentgenographic evaluation of lumbar spine lexion-extension in asymptomatic individuals. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis.
In such a situation thyroid symptoms and treatment 200 mcg levothroid order otc, performing a thoracoscopic surgery anterior hemivertebra excision is feasible in a combined-approach fashion. It should be noted that for children who are younger than 5 years who require anterior fusion over few levels of the spine, the beneit from a thoracoscopic approach may be limited. Lung delation is more diicult in these cases because standard-size double-lumen and bronchial blocking endotracheal tubes are too large. Another restriction is the markedly reduced working distance between the chest wall and the spine. In severe cases of scoliosis, the reduced distance limits the ield of vision (in that the endoscope is too close to the spine to obtain any perspective) and the maneuverability of the working instruments. A minimum distance of 2 to 3 cm of working space between the rib cage and the spinal column is required to provide adequate visualization. Surgical Technique here are a number of special equipment needs for the safe performance of thoracoscopic surgery. High-quality endoscopes (10-mm diameter and 0-, 3-, and 45-degree angled optics), video camera, light source, and monitor have become standard in nearly all modern operating rooms. An endoscopic suction-irrigation device, an ultrasonic dissector, and electrocautery are positioned at the head of the operating table. Some authors have suggested that prone positioning may be possible in select cases, which avoids the need to reposition the patient for the posterior procedure and allows anterior release and posterior instrumentation simultaneously. Complete ipsilateral lung delation is essential to prevent lung parenchymal injury from passing instruments and to allow visualization of the spine. Double-lumen endotracheal tubes are preferred in patients large enough (>45 kg) to accept these devices. In children (<45 kg), selective intubation of a single lung is oten required as an alternative. A small balloon advanced into the main stem bronchus blocks ventilation to the lung on the operative side. In nearly all patients with normal preoperative pulmonary function, single-lung Scrub Video ventilation can be tolerated. Owing to the site of diaphragm insertion, the inferior portals require a slightly more posterior placement to maintain an intrathoracic position. A fan retractor is oten required early in the procedure before complete atelectasis of the lung has occurred. Division of the pleura overlying the spine may be performed either longitudinally, over the length of the spine to be fused, or transversely, at each disc space. In most cases, we prefer a longitudinal pleural exposure with division of the segmental vessels using harmonic coagulation.
In general thyroid operation order levothroid 200 mcg online, curves no greater than 25 degrees that are limited to no greater than ive vertebrae may be considered. Additionally, lordosis in the proposed region of fusion is a contraindication to posterior fusion because anterior growth will worsen lordosis. A review of 54 congenital scoliosis patients reported a 15% crankshat incidence in patients undergoing posterior fusion before the age of 10 years, especially those with surgery at an early age and greater than 50-degree curves. In a large meta-analysis review of patients with early-onset scoliosis, congenital scoliosis, and infantile scoliosis who underwent posterior spinal fusion for presumed deinitive fusion in early childhood, revision surgery has been required in 24% to 39% of cases. Imaging the spine prior to exposure is useful because the area of deformity is oten diicult to localize by inspection and palpation alone. During exposure, failure to recognize the potentially complex posterior laminar defects can lead to neurologic injury. Ater exposure of the posterior elements, the spine should again be imaged to conirm that the targeted deformity, which may have anterior components, aligns with posterior elements. Some deformities, particularly anterior bars or malaligned hemivertebrae, have anterior elements that do not correspond to the logical posterior elements. Due to diicult localization of the deformity, there is a risk of extending the fusion past the originally planned surgery. Fusion must include all vertebrae involved in the congenital curve and should extend laterally to the transverse processes. Successful fusion is achieved by thorough facet resection, decortication, and placement of abundant bone grat. Posterior instrumentation can be used safely in the pediatric patient to decrease the risk of pseudarthrosis. Of course, posterior elements may be deformed, with fused or missing laminae, or thin pedicles that do not lend themselves well to instrumentation. With advancing age, typically by the age of 2 years, instrumentation becomes feasible. A postoperative cast or a rigid brace is then required for 2 to 3 months to achieve fusion and curve correction. Convex hemiepiphysiodesis slows convex-side growth while the concave curve still grows, allowing for safe and relatively controlled progressive deformity correction. Ideal candidates for convex hemiepiphysiodesis are young enough that growth will allow for signiicant correction, a curve less than 70 degrees, have six or fewer involved vertebrae, and demonstrate signiicant concave growth potential. Convex hemiepiphysiodesis typically requires an anterior and posterior exposure; however, posterior-only methods are feasible. Traditional convex hemiepiphysiodesis without instrumentation typically yields modest curve correction, on the order of 0 to 15 degrees by maturity; some patients achieve only an arrest of progression.
Ford, 33 years: However, all patients are at some risk for pseudarthrosis ater posterior instrumentation and fusion procedures. The possibility of a junctional kyphosis should be discussed with the patient and family preoperatively. Until age 7, it is acceptable to have anterior wedging of the subaxial cervical vertebrae, which should not be confused with anterior compression fractures. In this article, intention-to-treat analysis showed no statistical diferences between surgery and nonoperative treatment of lumbar disc herniations.
Julio, 42 years: Reversing the inhibitory efect of nicotine on spinal fusion using an osteoinductive protein extract. Injuries involving the conus medullaris and cauda equina (or lumbosacral nerve roots) may be complete or incomplete, and are usually classiied descriptively according to the level of nerve roots involved. Our preference for lateral corpectomy is to perform discectomy at the proximal disc space, identify the pedicle and posterior body wall, and then perform caudal interbody space discectomy. A subset of patients will have radiographic evidence of mild, nonprogressive instability.
Merdarion, 27 years: Comparison of transforaminal lumbar interbody fusion performed with unilateral pedicle screw ixation or unilateral pedicle screw-contralateral percutaneous transfacet screw ixation. However, in one recent study, a higher rate of failure was associated with this technique compared with more typical iliac ixation with lateral connectors (25% vs. Gabapentin resulted in signiicantly increased walking distance, as well as improved pain scores and recovery of sensory deicits. Bridging the transected or contused adult rat spinal cord with Schwann cell and olfactory ensheathing glia transplants.
Ramirez, 40 years: Both functions demand strength, coordination, and cooperation one would expect from an athletic child. A European economic evaluation of a randomized controlled study258 of intensive group therapy found no signiicant cost diference between intensive group therapy and standard physiotherapy. A study by Matsunaga and colleagues24 represented the best of the three studies and was the only true natural history study. However, due to a lack of quality literature, none of the commonly used nonoperative therapies has been proven to alter the long-term course of disease.
Cole, 47 years: Right thoracic curve and compensatory lumbar curve remain relatively unchanged from birth at (A) age 1 year and (B) age 8 years. Can intraoperative spinal cord monitoring reliably help prevent paraplegia during posterior vertebral column resection surgery Fusion remains the method of choice for advanced disc/facet degeneration and gross instability. In contrast, 5 of 8 patients (63%) undergoing decompression with in situ posterolateral fusion achieved a satisfactory outcome.
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