Clinical spine surgery
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Clinical spine surgery · Feb 2016
ReviewClinical and Radiographic Evaluation of Adult Spinal Deformity.
Adult spinal deformity (ASD) is a complex disease comprised of different deformity types that often involve the entire spine. Accurate assessment of ASD requires a thorough radiographic evaluation of both the spine and pelvis, including concomitant assessment of the cervical, thoracic, and lumbar spine, as well as the femoral heads and pelvis. Radiographic measurements should include assessment of regional alignment (including lumbar lordosis, thoracic kyphosis, C2-C7 lordosis), global alignment (including C7 SVA, C2-C7 SVA, and T1 pelvic angle), and measures of pelvic compensation and morphology (pelvic tilt, pelvic incidence, T1 slope, and C2-pelvic tilt). ⋯ ASD surgical planning must integrate regional, global, and pelvic compensatory/morphologic parameters to adequately correct deformity and thereby provide pain relief and improve function. Radiographic classifications for cervical and thoracolumbar deformities have been developed that utilize the regional and global measures of spinal deformity that are most predictive of patient-reported pain and function. These classifications are aimed to standardize the assessment of ASD to aid in clinical management and to facilitate future research on the evaluation and treatment of ASD.
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Clinical spine surgery · Feb 2016
Comparative StudyExpansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment?
Intervention comparison study. ⋯ Posterior surgeries resulted in clinical improvements although with loss of cervical lordosis in CSM with OPLL patients. OPLL may worsen more frequently after LA. LF and laminoplasty are preferable techniques in this condition, with the former better for patients with high baseline SVA distances.
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Clinical spine surgery · Feb 2016
Comparative StudyConservative and Operative Treatment in Extension Teardrop Fractures of the Axis.
A retrospective case series describing teardrop fracture of the axis. ⋯ Most patients with an extension teardrop fracture of the axis can be treated conservatively. On the basis of this case series, the authors suggest that large fragment size, displacement or angulation, intervertebral disk injury, neurologic deficit, or signs of instability are reasonable indications for surgical treatment.
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As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. ⋯ Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.