Paul M. Lin

A technical modification of Cloward's posterior lumbar interbody fusion.

The concept of interbody (intercorporal) fusion as a useful treatment for intervertebral disc disease in the cervical area has been well received. Thirty-two years have passed since Cloward first introduced his technique of posterior lumbar intervertebral fusion. The author believes that the delayed acceptance of this procedure is due to fear of technical difficulties. A technical modification of Clowards posterior lumbar interbody fusion is introduced. It entails better technique in controlling epidural bleeding by careful positioning of the patient and the use of oxidized cellulose as a tampon in the epidural space. The integrity of the facet is preserved through a more limited interlaminal approach. Osteosynthesis of the grafts is assured by multiple perforations of the cortical plate in accordance with Robinsons principle utilized in cervical interbody fusion. The author believes that the modification simplifies the Cloward posterior lumbar interbody fusion. It also assures better stability after surgery by retention of the facet and lessening the dangers of settlement of the graft by preservation of the cortical plate. In a series of 75 cases, tomograms made 4 months after operation have shown a viable graft with active osteosynthesis between the graft and the adjoining vertebral bodies in 94%.

A Technical Modification of Clowardʼs Posterior Lumbar Interbody Fusion

The concept of interbody (intercorporal) fusion as a useful treatment for intervertebral disc disease in the cervical area has been well received. Thirty-two years have passed since Cloward first introduced his technique of posterior lumbar intervertebral fusion. The author believes that the delayed acceptance of this procedure is due to fear of technical difficulties. A technical modification of Clowards posterior lumbar interbody fusion is introduced. It entails better technique in controlling epidural bleeding by careful positioning of the patient and the use of oxidized cellulose as a tampon in the epidural space. The integrity of the facet is preserved through a more limited interlaminal approach. Osteosynthesis of the grafts is assured by multiple perforations of the cortical plate in accordance with Robinsons principle utilized in cervical interbody fusion. The author believes that the modification simplifies the Cloward posterior lumbar interbody fusion. It also assures better stability after surgery by retention of the facet and lessening the dangers of settlement of the graft by preservation of the cortical plate. In a series of 75 cases, tomograms made 4 months after operation have shown a viable graft with active osteosynthesis between the graft and the adjoining vertebral bodies in 94%.

The diagnostic importance of normal variants in deep cerebral phlebography, with special emphasis on the true and false venous angles of the brain and evaluation of venous angle measurements.

The value of the deep cerebral veins in cerebral angiography, as an aid in localizing space-taking intracranial lesions, has been well established by a number of investigators. Particular attention has been directed to localization of the foramen of Monro through visualization of a characteristic vein coursing through it. This vein, formed by the junction of the striothalamic (terminal) with the internal cerebral vein, forms a smooth, sharp curve as it courses around the posterior margin of the foramen. The point at which the two veins join has been called by Krayenbuhl and Richter the “venous angle of the brain” (V-A) (Fig. 1). The deep cerebral veins have a fairly constant course and configuration. Exceptions are not unusual, however, and should be distinguished from pathologic changes. It is the purpose of this paper to show the normal variations of the deep veins and sinuses and various types of tributaries of the internal cerebral vein which result in a false “venous angle of the brain,” and to discu...

Collateral circulation of the external carotid artery and the internal carotid artery through the ophthalmic artery in cases of internal carotid artery thrombosis; report of five cases.

Occlusion or thrombosis of the internal carotid artery in the neck is being recognized more frequently. Gross (2), Johnson and Walker (4), and others have described this condition and all stress the importance of angiographic findings in diagnosis. Gurdjian and Webster (3) pointed out, in addition, the value of intraoral palpation of the artery in establishing the occlusion. Exploration of the internal carotid artery in the neck and, if feasible, section of the vessel offer the definitive diagnosis. It is known that in internal carotid artery occlusion, the defective cerebral circulation can be improved by collateral circulation through the circle of Willis. If this latter circulation is inadequate, due to under-development of the anterior and the posterior communicating artery, collateral circulation can be established through anastomosis of the branches of the external carotid artery, mainly the internal maxillary artery and the facial artery, with the ophthalmic artery. Marx (6) was the first to report...

Radiological Evidence of Posterior Lumbar Interbody Fusion

The objective of posterior lumbar interbody fusion (PLIF) is bony arthrodesis or an anatomic fusion. There has been no clear acceptance concerning what roentgenologically constitutes a fusion or arthrodesis in PLIF. Conceptually, there are two objectives in PLIF. The first as proposed by Collis [1] is lumbar disk replacement by means of biocompatible bone grafting, or osteointegration. The second objective of PLIF is bony arthrodesis, or an anatomic fusion.