Journal of spinal disorders & techniques
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J Spinal Disord Tech · Feb 2005
Randomized Controlled Trial Multicenter Study Clinical TrialIliac crest bone graft donor site pain after anterior lumbar interbody fusion: a prospective patient satisfaction outcome assessment.
Autogenous iliac crest bone is the gold-standard graft for spinal fusion surgery. Unfortunately, there is a frequent incidence of graft site pain that persists well into the postoperative period with complication rates reported in 2.8-39% of patients. Persistent pain lasting at least 2 years is reported in 15-39% of patients. ⋯ Persistent donor site pain remains a problem with harvest of autogenous iliac crest bone graft for spinal fusion. This prospective study, the first such study reported for ALIF, confirms that donor site pain remains a significant postoperative management problem.
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J Spinal Disord Tech · Feb 2005
Comparative StudyA variability study of computerized sagittal spinopelvic radiologic measurements of trunk balance.
The accurate measurement of spinal and pelvic alignment in the sagittal plane is of prime importance for various disorders. Pelvic incidence (PI) is a fundamental anatomic parameter that is specific and constant for each adult individual and is related to pelvic orientation as well as to the size of lumbar lordosis (LL). It is the summation of the sacral slope (SS) and pelvic tilt (PT), two position-dependent variables that determine pelvic orientation in the sagittal plane. The authors have proposed a computer software designed to measure PI, SS, PT, LL, and thoracic kyphosis (TK) on standardized standing lateral digitized x-rays of the spine and pelvis. The purpose of this study was to evaluate the inter- and intraobserver variability of measurements using this software, to determine if it can be used reliably in a clinical environment. ⋯ We conclude that the variability of measurements with this method is lower than with similar radiologic measures done manually and that the use of this software can be recommended for future clinical and research studies of spinopelvic sagittal balance.
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J Spinal Disord Tech · Feb 2005
Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc.
In industrialized societies, the prevalence of radicular low back pain has exploded in recent years. The growing economic and personal costs of this challenging entity have led to the development of a wide array of new treatments, ranging from pharmacotherapy with neuropathic medications to open surgical treatment. Among the therapeutic options to emerge are a plethora of minimally invasive treatments aimed at removing nuclear material and lowering intradiscal pressure through devices inserted percutaneously into intervertebral discs. Yet there is a compelling lack of clinical evidence to support the use of these procedures. This study was undertaken to determine the treatment outcomes of 16 consecutive patients with lumbar radicular pain secondary to a herniated disc who underwent nucleoplasty as their primary therapy. ⋯ We conclude that with use of the present selection criteria, nucleoplasty is not an effective long-term treatment for lumbar radiculopathy, either alone or with IDET. Before conducting future clinical trials, we recommend modifying these criteria to include only those patients with small (<6-mm) contained disc herniations whose annular integrity is documented by computed tomography discography and corresponding radicular symptoms confirmed by either selective nerve root blocks or electromyography and nerve conduction studies.
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J Spinal Disord Tech · Feb 2005
Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure.
Vacuum-assisted wound closure (VAC) exposes the wound bed to negative pressure, resulting in removal of edema fluid, improvement of blood supply, and stimulation of cellular proliferation of reparative granulation tissue. It has been used to treat open wounds in the extremities, open sternal wounds, pressure ulcers, and abdominal wall wounds. This study retrospectively reviewed instrumented spine fusions complicated by surgical wound infection and managed by a protocol including the use of VAC in order to evaluate the efficacy of applying vacuum therapy on patients with deep spine infections and exposed instrumentation. ⋯ VAC therapy is an effective adjunct in closing complex deep spinal wounds with exposed instrumentation.
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The sacral perineural cyst was first described by Tarlov in 1938 as an incidental finding at autopsy. There are very few data in the literature regarding the role of Tarlov cysts in causing symptoms, however. Most studies report low numbers, and consequently, the recommendations for treatment are vague. Our aim, therefore, is to present further detail regarding the clinical relevance of Tarlov cysts and to identify whether or not they are a cause of lumbosacral spinal canal stenosis symptoms. ⋯ The majority of Tarlov cysts are incidental findings on MRI. Where confusion exists as to the clinical relevance of a Tarlov cyst, treatment of the primary pathology (ie, non-Tarlov lesion) is usually sufficient. Tarlov cysts may, however, be responsible for a patient's symptoms; possible mechanisms by which this may occur and treatment strategies are discussed.