Biomedical subjects

Harel Deutsch

Publications and source records attributed to Harel Deutsch.

10 recordsLinked to original sources

PubMed2007

The decision-making process: allograft versus autograft.

The decision whether to use allograft or autograft in ventral cervical fusions has been widely discussed. The literature includes several prospective randomized trials. Extensive clinical evidence indicates that autograft use results in increased arthrodesis rates and less graft collapse. However, autograft harvest has a substantial morbidity rate. Allografts avoid the morbidity associated with autograft harvest but result in decreased arthrodesis rates and increased graft collapse rates. The decreased arthrodesis rate associated with allografts becomes more significant in multilevel surgery and in patients who smoke. The introduction and use of ventral cervical plates have made allograft use more attractive by increasing arthrodesis rates and decreasing graft collapse.

Bone Transplantation↗

PubMed2006

Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation.

OBJECT: Posterior lumbar interbody fusion (PLIF) has been shown to be effective in the treatment of axial low-back pain. Minimally invasive spine surgery for arthrodesis has several advantages, including quicker patient recovery, less postoperative pain, and less destruction of adjacent tissue. The purpose of this paper is to evaluate the clinical outcomes after PLIF procedures in which unilateral pedicle screw fixation was used. METHODS: Prospective data were collected in 34 patients undergoing a one-level minimally invasive transforaminal lumbar interbody fusion (TLIF) in 2003. Conservative therapy, including physical therapy and aggressive multimodality pain management, had failed in all patients. Selection was based on magnetic resonance imaging studies demonstrating degenerative disc disease. All patients underwent a unilateral TLIF procedure in conjunction with posterior unilateral pedicle screw fixation. Twenty patients in whom the follow-up duration was longer than 6 months were included in this study. The follow-up duration in all patients ranged from 6 to 12 months. Seventeen (85%) of 20 patients had a good result, which was defined as a greater than 20-point reduction in the Oswestry Disability Index (ODI) score. The other three patients had no improvement. The mean preoperative ODI score of 57 improved to 25 after surgery (p < 0.005). In the 17 patients who demonstrated improvement, the mean ODI score improved from 57 to 18. The patients' visual analog scale pain scores improved from 8.3 to 1.4 (p < 0.005) after surgery. In patients who received Workers' Compensation, three (75%) of four improved. Follow-up computerized tomography scans were obtained in all 20 patients at 6 months. At that time, 13 of the patients demonstrated some degree of fusion, and no symptomatic pseudarthrosis was noted. CONCLUSIONS: Minimally invasive TLIF in conjunction with unilateral pedicle screw instrumentation is an effective treatment for axial low-back pain in appropriately selected patients.

Adult↗

PubMed2006

Cervicothoracic kyphosis.

Cervicothoracic kyphotic deformity may inhibit horizontal gaze function, impede activities of daily living, and induce disabling pain. Eventually, some patients develop a chin-on-chest deformity that limits their ability to eat and drink; in the end stage, a few patients also may have difficulty breathing. Progressive kyphosis can stretch the spinal cord leading to myelopathy with progressive lower extremity spasticity and weakness. Indications for surgery include myelopathy, pain, dysphagia or dyspnea owing to kyphosis, and difficulty maintaining a functional horizontal gaze. Patients with unstable cervicothoracic fractures also require surgical fixation. For these patients, surgical goals include deformity correction with restoration of an acceptable forward gaze, re-establishment of sagittal balance, decompression of the spinal cord (if myelopathic), and stable fixation.

Cervical Vertebrae↗

PubMed2005

Cervical stenosis presenting with acute Brown-Séquard syndrome: case report.

STUDY DESIGN: An unusual case report of cervical stenosis presenting with the Brown-Séquard syndrome. Technical considerations and a literature review are discussed. OBJECTIVE: To evaluate cervical stenosis as an etiology of the Brown-Séquard syndrome and whether surgical decompression is effective for improving neurologic outcome. SUMMARY OF BACKGROUND DATA: Of the causes of the Brown-Séquard syndrome, intrinsic cervical spine pathology has rarely been reported in the literature. We report the first case of a chronic cervical stenosis presenting with an acute Brown-Séquard syndrome after a severe coughing episode. METHODS: A 75-year-old woman with a previous history of cervical stenosis had sudden onset of weakness develop in the right upper and lower extremities, and disruption of pain and temperature sensation on the left side of her body after an episode of severe coughing associated with pneumonia. Magnetic resonance imaging of the cervical spine revealed severe canal stenosis from C3 through C7, with diffuse intramedullary hyperintensity consistent with myelomalacia of the cervical cord. A decompressive cervical laminectomy with fusion was performed. RESULTS: The patient improved neurologically, with near complete resolution of the right hemiparesis at 6-month follow-up. CONCLUSION: Multilevel chronic cervical stenosis can present with an acute Brown-Séquard syndrome. Cervical laminectomy and decompression are effective treatments for cervical stenosis with an acute Brown-Séquard syndrome.

Acute Disease↗

PubMed2005

Occipitocervical fixation: long-term results.

STUDY DESIGN: The study is a retrospective review of 58 patients who underwent occipitocervical fusion between 1997 and 2001. OBJECTIVES: Our objective is to study the clinical results after occipitocervical fixation with long-term follow-up and assess factors contributing to clinical success. METHODS: Data from patient charts, operative notes, physician office notes, and imaging studies were incorporated in the study. Myelopathy was assessed using a Nurick scale for preoperative and postoperative evaluation. Fusion was assessed using cervical plane films with flexion and extension views. RESULTS: Mean follow-up was 36 months, with all patients having a greater than 1-year follow-up. The most common pathology was congenital cranial settling (41%) followed by trauma (22%) and rheumatoid arthritis (17%). Myelopathy was the most common presentation (62%) followed by pain (28%). A successful fusion occurred in 48 out of 51 patients (94%). Symptoms improved in 86% of patients, whereas 35% improved 1 Nurick grade. Complications occurred in 30% of patients. The cervical wound infection rate was 5%. The rate of adjacent level degeneration was 7%. The mortality rate was 1.7%. CONCLUSIONS: Occipitocervical instrumentation allows for very high fusion rates without the need for halo vest immobilization. All patients with successful fixation have pain resolution. Myelopathy improves in most patients, whereas one-third of patients demonstrate dramatic improvement.

Adolescent↗

PubMed2005

Palsies of the fifth cervical nerve root after cervical decompression: prevention using continuous intraoperative electromyography monitoring.

OBJECT: A desire to prevent complications resulting from spinal surgery led to the development of intraoperative monitoring. Intraoperative electromyography (EMG) provides useful diagnostic information regarding nerve root function during spinal and peripheral nerve surgeries. The C-5 nerve root is considered particularly vulnerable to injury during cervical surgery. Despite advances in techniques, the incidence of postoperative C-5 palsy has not changed. METHODS: The authors reviewed prospectively collected data obtained in 161 patients who underwent 171 cervical procedures. In 116 procedures, operative monitoring was modified to include continuous C-5 EMG from the deltoid muscle. In cases in which spontaneous C-5 activity occurred, an appropriate change in operative manipulation was made. A historical control group consisted of a retrospective review of 55 procedures that were monitored using conventional techniques. In the retrospective cohort, four (7.3%) of 55 patients presented after undergoing surgery for C-5 nerve root palsy. In each patient conventional monitoring revealed unremarkable findings. In the prospective cohort, intraoperative spontaneous EMG activity necessitated a change in either positioning or operative technique in three cases. Only one patient (0.9%) experienced postoperative C-5 palsy. Postoperative C-5 palsy occurred in no patient in whom there was no intra-operative evidence of root irritation (p < 0.03, chi-square test). CONCLUSIONS: The incidence of postoperative C-5 palsies was reduced from 7.3% to 0.9% due to intraoperative continuous EMG monitoring. No patient suffered a postoperative C-5 palsy when intraoperative evidence of root irritation was absent.

Case-Control Studies↗

PubMed2004

Lower dose intraventricular T-PA fibrinolysis: case report.

BACKGROUND: Recombinant tissue plasminogen activator (rtPA) intraventricular fibrinolysis has been demonstrated to be efficacious in clearing blood from the ventricular system. Preliminary studies indicate it may improve survival. There have also been reports of adverse affects from intraventricular fibrinolysis. Optimal dosing of rtPA has not been established. METHODS: A 40-year-old patient with intraventricular hemorrhage extension secondary to a ruptured aneurysm was treated with a one-time infusion of 1 mg of rtPA through a right ventriculostomy. RESULTS: Computed tomography scans demonstrated excellent resolution of intraventricular blood and improvement in cerebral spinal fluid flow after fibrinolysis. Fibrinolysis was most marked in the third and fourth ventricles. There were no adverse effects noted. CONCLUSIONS: Intraventricular fibrinolysis is effective at a lower dose than previously used. Lower doses may have fewer adverse affects.

Adult↗

PubMed2004

Posterior cervical laminoplasty using a new plating system: technical note.

BACKGROUND: Laminoplasty is well described in the Japanese literature as a surgical option for treating ossification of the posterior longitudinal ligament (OPLL). The open door technique has gained increasing popularity in the United States and Europe to treat not only OPLL but also cervical stenotic myelopathy. An obstacle to its widespread use is the lack of a suitable fixation plate to adequately secure the fractured lamina to the lateral mass. Our objective was to demonstrate the advantages of a novel miniplate (Ti-Mesh LP system; Medtronic Sofamor Danek, Memphis, TN, USA) that is ideally suited for fixing the lamina to the lateral mass. METHODS: We used the Ti-Mesh LP miniplate system to perform laminoplasties on five patients, all male, with a mean preoperative Nurick score of 2.8. Four patients had congenital cervical stenosis with myelopathy and one had OPLL. Open door laminoplasties were performed on all patients. The plates were implanted with a claw positioned on the trapdoor lamina and a flat plate on the lateral mass. RESULTS: The system was implanted successfully in all patients. The mean number of levels fixated was 4.4. There were no intraoperative or postoperative complications after >5 months follow-up. CONCLUSIONS: The new Ti-Mesh LP cranial miniplate and screw system facilitates posterior cervical laminoplasty procedures by eliminating the need to contour cranial miniplates for use in the cervical spine. Its unique claw construct and angled design are ideal for holding a trapdoor laminoplasty in the open position. We have used this system successfully and without complications to perform decompressive posterior cervical laminoplasties in five patients.

Aged↗

PubMed2003

Postlaminectomy cervical deformity.

Postlaminectomy cervical kyphosis is an important consideration when performing surgery. Identifying factors predisposing to postoperative deformity is essential. The goal is to prevent postlaminectomy cervical kyphosis while exposing the patient to minimal additional morbidity. When postlaminectomy kyphosis does occur, surgical correction is often required and performed via an anterior, posterior, or combined approach. The authors discuss the indications for surgical approaches as well as clinical results.

Adult↗

PubMed2003

Benign sacral tumors.

Primary tumors of the sacrum are rare. In adults, the most common sacral tumors are metastases. The most common primary sacral tumor is a chordoma. Chordomas along as well as tumors such as chondrosarcomas, osteosarcomas, myxopapillary ependymomas, myelomas, and Ewing sarcomas are considered malignant. In this article the authors focus on benign sacral tumors.

Adolescent↗