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A 6 year follow-up prospective study of 289 patients with the Charite artificial disc prosthesis
Abstracts / Surgical Neurology 68 (2007) 192–204 Methods: A review of all 19 patients who underwent this operation done by 1 surgeon between May 2005 and January 2007. Results: Twenty aneurysms were clipped via minicraniotomy in 18 patients; in 1 patient during operation, this extended to a classic pterional approach. Seven patients presented with acute subarachnoid hemorrhage, and 11 patients were admitted for elective clipping. In 2 patients, 2 aneurysms were clipped via a single craniotomy. All patients were successfully clipped. Advantages of this approach include minimal disruption and exposure of the normal brain tissue, reduced frontal lobe retraction observed by microdialysis during operation, and an excellent postoperative cosmetic result. There were some minor postoperative complications. Conclusion: This microsurgical technique via the supraorbital keyhole approach is a safe, minimally invasive, and effective method to treat aneurysms in the anterior circulation. doi:10.1016/j.surneu.2007.06.061
Microvascular compressions and tinnitus: a neurophysiological approach D. De Ridder, B. Haarman, K. Heijneman, E. van der Loo, M. Plazier, D. Van der Planken, S. Rooker, T. Menovsky Antwerp Introduction: Microvascular decompressions for tinnitus bear a poor prognosis in contrast to other microvascular compression syndromes. No generally accepted criteria exist for selecting the correct candidates for surgery. The aim of the article is to develop a pathophysiologic approach for evaluating auditory brainstem response (ABR) changes that could benefit surgeons performing microvascular decompressions for tinnitus. Materials and methods: A new classification, with increasing likelihood of cochleovestibular compression being the cause of tinnitus, is used to evaluate ABR changes as they develop in time. In a retrospective study of 78 patients with tinnitus belonging to these different groups, tinnitus duration and tinnitus intensity are correlated to peak II and interpeak latency (IPL) I-III changes. Results: In MVC of the vestibulocochlear nerve, a sequential pattern of ABR changes can be noted. In the first 2 years no ABR changes are observed, followed sequentially by a decrease in the ipsilateral peak II amplitude and ipsilateral IPL I-III prolongation. The rate of IPL I-III increase slows down after 10 years. These ABR changes might be the neurophysiologic correlate of pathophysiologic changes at a neuronal level, with initially localized dys-synchronized firing not being picked up by the ABR, followed by more widespread dys-synchronized firing of compressed nerve fibers (peak II amplitude decrease), followed by demyelination resulting in slowing of nerve conduction (IPL I-III increase) on the affected side. Conclusions: Interpreting an ABR from a pathophysiologic point of view can be beneficial for surgeons performing microvascular decompressions for tinnitus, especially with regard to timing of the surgery. doi:10.1016/j.surneu.2007.06.062
Cervical arthrodesis and prevention of adjacent degeneration G. Matgé Luxembourg Cervical disk surgery, mainly by anterior approach with fusion, is believed to accelerate adjacent-level degeneration (AD). Dynamic cervical implant developed by the author was tested in 10 patients with more than 2 years follow-up. Indications were the same as for total disk replacement, with simplicity of cage implantation. The goal was preservation of motion as long as possible and avoidance of AD. Retrospective studies about cervical fusion estimate a 25% risk of AD at 10 years (more radiologic than clinical), with a mean reoperation rate of 7% to
203
15%. Critics evoke natural degeneration, but also AD in posterior approach without fusion. A recent prospective study “cage vs prosthesis” shows for the first time a significant incidence of AD and reoperation rate in the fusion group compared to the nonfusion group. The same protective effect was found in this preliminary study with dynamic cervical implant. Motion was preserved in 8 cases. One early migration for technical error was treated by cage fusion. A slow fusion at 18 months was observed in the first treated patient, without AD at 4 years follow-up. Cervical spine arthrodesis is involved in AD. Delaying fusion as long as possible with arthroplasty seems wise. Slow fusion may also reduce AD. doi:10.1016/j.surneu.2007.06.063
A 6 year follow-up prospective study of 289 patients with the Charite artificial disc prosthesis G. Lesage, R. Hes, B. Conix, G. Dua Antwerp Introduction: Lumbar total disk replacement (TDR) provides an alternative to spinal fusion for patients with DDD. The best indications for TDR are young and active patients with severe discogenic low back pain. The Charité prosthesis is designed to restore near-physiologic motion to the affected segment, maintain or restore disk height, while adjacent-level degeneration may be prevented. Methods: Between September 1999 and January 2006, 289 patients were implanted with the third-generation Charité disk prosthesis, for a total of 346 levels. A total of 225 patients were implanted at 1 level, 59 patients at 2 levels, and 1 patient at 3 levels. All patients received preoperative standardized exams: magnetic resonance imaging, x-ray, bone scintigraphy, and discography. Clinical results were recorded with Visual Analogue Scale (VAS) for leg and back pain and with Oswestry Disability Index (ODI) score. Results: Mean (SD) preoperative leg and back pain as recorded on VAS was 4.85 (3.45) and 7.35 (2.47), respectively. Overall, at the time of last followup assessment, the mean (SD) change in leg pain was −3.6 (3.7) and in back pain it was −5.6 (3.18). Mean preoperative (SD) ODI score was 44.81 (18.80). Mean (SD) change in ODI was −32.40 (22.80). At all follow-up assessments, leg and back pain VAS and ODI score was statistically significantly lower compared to presurgery levels. No statistically significant difference was noted between sex or age groups. All levels remained mobile on dynamic x-rays in 106 patients followed up for a minimum of 2 years. Two patients needed subsequent second-level TDR. Discussion: This prospective study demonstrates the safety and long-term efficacy of TDR with the Charité disk prosthesis. In this 6-year follow-up prospective study, TDR proves to be a viable alternative for preservation of motion in the lumbar spine with very good clinical results with the additional advantage of prevention of adjacent-level degeneration. (There is real concern that the information being obtained about artificial disks is not credible because the selection of patients is variable and the psychosocial factors are not considered in this selection process. The details of patient selection are not stated here in this large series although they may have been stated in the talk.—Ed) doi:10.1016/j.surneu.2007.06.064
Total disk arthroplasty: a comparative clinical and 3D electrogoniometric prospective study after 1 year J.-B. Dandine, P. Salvia, A. Lubansu, M. Rooze, J. Brotchi, O. Dewitte Brussels A prospective clinical and biomechanical study was undertaken to evaluate the outcome after lumbar artificial disk replacement. The objective was to compare the 1-year results of 2 types of artificial disk prosthesis in patients with degenerative disk disease.
Microvascular compressions and tinnitus: a neurophysiological approach D. De Ridder, B. Haarman, K. Heijneman, E. van der Loo, M. Plazier, D. Van der Planken, S. Rooker, T. Menovsky Antwerp Introduction: Microvascular decompressions for tinnitus bear a poor prognosis in contrast to other microvascular compression syndromes. No generally accepted criteria exist for selecting the correct candidates for surgery. The aim of the article is to develop a pathophysiologic approach for evaluating auditory brainstem response (ABR) changes that could benefit surgeons performing microvascular decompressions for tinnitus. Materials and methods: A new classification, with increasing likelihood of cochleovestibular compression being the cause of tinnitus, is used to evaluate ABR changes as they develop in time. In a retrospective study of 78 patients with tinnitus belonging to these different groups, tinnitus duration and tinnitus intensity are correlated to peak II and interpeak latency (IPL) I-III changes. Results: In MVC of the vestibulocochlear nerve, a sequential pattern of ABR changes can be noted. In the first 2 years no ABR changes are observed, followed sequentially by a decrease in the ipsilateral peak II amplitude and ipsilateral IPL I-III prolongation. The rate of IPL I-III increase slows down after 10 years. These ABR changes might be the neurophysiologic correlate of pathophysiologic changes at a neuronal level, with initially localized dys-synchronized firing not being picked up by the ABR, followed by more widespread dys-synchronized firing of compressed nerve fibers (peak II amplitude decrease), followed by demyelination resulting in slowing of nerve conduction (IPL I-III increase) on the affected side. Conclusions: Interpreting an ABR from a pathophysiologic point of view can be beneficial for surgeons performing microvascular decompressions for tinnitus, especially with regard to timing of the surgery. doi:10.1016/j.surneu.2007.06.062
Cervical arthrodesis and prevention of adjacent degeneration G. Matgé Luxembourg Cervical disk surgery, mainly by anterior approach with fusion, is believed to accelerate adjacent-level degeneration (AD). Dynamic cervical implant developed by the author was tested in 10 patients with more than 2 years follow-up. Indications were the same as for total disk replacement, with simplicity of cage implantation. The goal was preservation of motion as long as possible and avoidance of AD. Retrospective studies about cervical fusion estimate a 25% risk of AD at 10 years (more radiologic than clinical), with a mean reoperation rate of 7% to
203
15%. Critics evoke natural degeneration, but also AD in posterior approach without fusion. A recent prospective study “cage vs prosthesis” shows for the first time a significant incidence of AD and reoperation rate in the fusion group compared to the nonfusion group. The same protective effect was found in this preliminary study with dynamic cervical implant. Motion was preserved in 8 cases. One early migration for technical error was treated by cage fusion. A slow fusion at 18 months was observed in the first treated patient, without AD at 4 years follow-up. Cervical spine arthrodesis is involved in AD. Delaying fusion as long as possible with arthroplasty seems wise. Slow fusion may also reduce AD. doi:10.1016/j.surneu.2007.06.063
A 6 year follow-up prospective study of 289 patients with the Charite artificial disc prosthesis G. Lesage, R. Hes, B. Conix, G. Dua Antwerp Introduction: Lumbar total disk replacement (TDR) provides an alternative to spinal fusion for patients with DDD. The best indications for TDR are young and active patients with severe discogenic low back pain. The Charité prosthesis is designed to restore near-physiologic motion to the affected segment, maintain or restore disk height, while adjacent-level degeneration may be prevented. Methods: Between September 1999 and January 2006, 289 patients were implanted with the third-generation Charité disk prosthesis, for a total of 346 levels. A total of 225 patients were implanted at 1 level, 59 patients at 2 levels, and 1 patient at 3 levels. All patients received preoperative standardized exams: magnetic resonance imaging, x-ray, bone scintigraphy, and discography. Clinical results were recorded with Visual Analogue Scale (VAS) for leg and back pain and with Oswestry Disability Index (ODI) score. Results: Mean (SD) preoperative leg and back pain as recorded on VAS was 4.85 (3.45) and 7.35 (2.47), respectively. Overall, at the time of last followup assessment, the mean (SD) change in leg pain was −3.6 (3.7) and in back pain it was −5.6 (3.18). Mean preoperative (SD) ODI score was 44.81 (18.80). Mean (SD) change in ODI was −32.40 (22.80). At all follow-up assessments, leg and back pain VAS and ODI score was statistically significantly lower compared to presurgery levels. No statistically significant difference was noted between sex or age groups. All levels remained mobile on dynamic x-rays in 106 patients followed up for a minimum of 2 years. Two patients needed subsequent second-level TDR. Discussion: This prospective study demonstrates the safety and long-term efficacy of TDR with the Charité disk prosthesis. In this 6-year follow-up prospective study, TDR proves to be a viable alternative for preservation of motion in the lumbar spine with very good clinical results with the additional advantage of prevention of adjacent-level degeneration. (There is real concern that the information being obtained about artificial disks is not credible because the selection of patients is variable and the psychosocial factors are not considered in this selection process. The details of patient selection are not stated here in this large series although they may have been stated in the talk.—Ed) doi:10.1016/j.surneu.2007.06.064
Total disk arthroplasty: a comparative clinical and 3D electrogoniometric prospective study after 1 year J.-B. Dandine, P. Salvia, A. Lubansu, M. Rooze, J. Brotchi, O. Dewitte Brussels A prospective clinical and biomechanical study was undertaken to evaluate the outcome after lumbar artificial disk replacement. The objective was to compare the 1-year results of 2 types of artificial disk prosthesis in patients with degenerative disk disease.