Clinical spine surgery
-
Clinical spine surgery · May 2016
The Compensatory Relationship of Upper and Subaxial Cervical Motion in the Presence of Cervical Spondylosis.
This study was an in vivo kinematic magnetic resonance imaging analysis of cervical spinal motion in human subjects. ⋯ Our study demonstrates that decreased subaxial cervical spinal motion is associated with intervertebral disk degeneration in a symptomatic population. This decrease in mobility at the subaxial cervical spine is compensated for by an increase in angular mobility of the upper cervical spine at the occipital-atlantoaxial complex, especially at Oc-C1.
-
Clinical spine surgery · Apr 2016
Multicenter StudyAccuracy of Pedicle Screw Placement in Children 10 Years or Younger Using Navigation and Intraoperative CT.
A consecutive case series. ⋯ In this series, image-guided navigation resulted in accurate placement of screws in patients aged 10 years or younger with no associated intraoperative complications. The navigated accuracy rate (97.8%) is significantly higher (P=0.01) than the reported 90.9% pedicle screw accuracy rate without navigation in the same age group by Baghdadi and colleagues. Intraoperative CT and image guidance were useful in our practice for placement of screws in skeletally immature patients.
-
The sacroiliac joint (SIJ) as a source of symptoms has been controversial; however, as knowledge about the joint increased, its role as a pain generator in patients complaining of symptoms that are often attributed to spinal pathology has become better appreciated. The literature reports that the SIJ is the pain origin in as many as 30% of patients presenting with low back pain. Clinically, the SIJ can be challenging to evaluate; however, assessing pain location, patient posture/movement, and provocative manual testing are useful in making the presumptive diagnosis of SIJ disruption. ⋯ If this does not provide adequate relief, surgical intervention, in the form of minimally invasive SIJ fusion may be considered. The literature increasingly supports favorable results of SIJ fusion in appropriately selected patients. The purpose of this review is to provide an overview of the current literature on the SIJ, with focus on its surgical treatment.
-
Clinical spine surgery · Mar 2016
Randomized Controlled TrialBipolar Sealer Device Reduces Blood Loss and Transfusion Requirements in Posterior Spinal Fusion for Degenerative Lumbar Scoliosis: A Randomized Control Trial.
A prospective, randomized, controlled clinical study. ⋯ Utilization of a bipolar sealer during correction of lumbar degenerative scoliosis may offer comparable hemostatic effects, without prohibitive cost or adverse drug-related risks.
-
Clinical spine surgery · Mar 2016
Comparative StudyCost-Utility Analysis of Anterior Cervical Discectomy and Fusion With Plating (ACDFP) Versus Posterior Cervical Foraminotomy (PCF) for Patients With Single-level Cervical Radiculopathy at 1-Year Follow-up.
A retrospective 1-year cost-utility analysis. ⋯ Statistically significant and clinically relevant improvements (through minimum clinically important differences) were seen in both cohorts. Although both cohorts showed improved health outcomes, ACDFP was not cost-effective relative to the threshold of $100,000/QALY gained at 1-year postoperatively, whereas PCF was. The durability of these results must be analyzed with long-term cost-utility analysis studies.