TAILIEUCHUNG - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 48

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 48. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Degenerative Disorders of the Cervical Spine Chapter 17 457 faces 218 Case Study 3 . Current indications and contraindications for TDA include 11 Table 7 Table 7. Indications and contraindications for TDA Indications symptomatic cervical disc disease one-or two-level involvement C3-T1 structural correlate . herniated nucleus pulposus cervical spondylosis failed conservative therapy of 6 weeks age between 20 and 70 years no contraindications Contraindications three vertebral levels requiring treatment cervical instability translation 3 mm and or 11 angulational difference cervical fusion adjacent to the target level previous surgery fracture at target level known allergy to implant materials severe spondylosis bridging osteophytes disc height loss 50 and absence of motion 2 facet joint OA axial neck pain as the solitary presenting symptom systemic and metabolic diseases AIDS HIV hepatitis B or C insulindependent diabetes infections obesity BMI 40 Preliminary outcome data demonstrated that TDA preserves segmental motion 50 185 in the short term and compares very favorably to ACDF in terms of clinical outcome 23 179 184 243 . However no convincing data was provided so far that TDA will prevent adjacent segment degeneration 243 . Posterior Laminectomy Cervical laminectomy was first performed by Sir Victor Horsley 1857 -1916 for the treatment of tumor related myelopathy 265 . Laminectomy is a versatile and technically facile approach to decompress the spinal cord 171 . Indications for laminectomy are mainly for the management of multilevel cervical myelopathy predominant posterior neural compression elderly CSM patients with comorbidities CSM with preserved cervical lordosis In elderly patients suffering from significant comorbidities and CSM due to multilevel spinal cord compression laminectomy is a short and effective procedure to arrest or improve neurological deficits. In the presence of kyphosis however laminectomy only has a limited effect since the spinal cord

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