Journal of spinal disorders & techniques
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J Spinal Disord Tech · Aug 2006
Risk factors for delayed extubation after single-stage, multi-level anterior cervical decompression and posterior fusion.
Airway difficulties after single-stage, multilevel anterior and posterior cervical surgery are potentially life-threatening complications. Although extubation delays can occur, overnight intubation can reduce the risk of postoperative airway emergencies. Our protocol was as follows: all patients were kept intubated overnight in an intensive care unit and examined by the intensive care unit staff each morning. ⋯ Delayed extubation was significantly related to total operative time (8.2 hours vs. 10.6 hours), volume of crystalloid replacement (3,627 cm3 vs. 6,218 cm3) and intraoperative blood transfused (0.7 units vs. 3.1 units); approaching significance was increased blood loss (1,238 mL vs. 2,820 mL). We have found intraoperative factors-operative time, crystalloid volume, blood loss and replacement-rather than patient characteristics, to be risk factors for delayed extubation. Good communication with anesthesia staff and careful attention to postoperative airway management is essential after single-stage, multilevel anterior cervical decompression and posterior fusion.
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J Spinal Disord Tech · Aug 2006
Use of recombinant human bone morphogenetic protein-2 as an adjunct in posterolateral lumbar spine fusion: a prospective CT-scan analysis at one and two years.
This study determines whether recombinant human bone morphogenetic protein-2 (rhBMP-2) (12 mg at the rate of 1.5 mg/mL) delivered on an absorbable collagen sponge with an added bulking agent can increase posterolateral lumbar spine fusion success rates and decrease time for fusion with autogenous bone grafts. ⋯ The adjunctive use of rhBMP-2 and ICBG seems to be safe and results in significantly larger and more consistent posterolateral fusion masses.
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J Spinal Disord Tech · Aug 2006
Clinical TrialLumbar total disc replacement using ProDisc II: a prospective study with a 2-year minimum follow-up.
A lumbar total disc replacement (TDR) is believed to be a promising substitute in the surgical treatment for lumbar degenerative disc disease. The purpose of this study is to report the clinical and radiographic outcomes of 36 consecutive patients who underwent lumbar TDR using ProDisc II, and the factors associated with a better clinical outcome after a 2-year minimum follow-up. At the time of the latest follow-up, the success rate was 94% of 36 patients according to the criteria of the US Food and Drug Administration. ⋯ Statistical analysis showed that the factors associated with a better clinical outcome were single level, and a higher postoperative segmental ROM at the operative level. At a minimum follow-up of 2 years, the lumbar TDR using ProDisc II showed excellent clinical and radiographic outcomes without any significant complication. However, future efforts need to be directed toward the evaluation of a larger number of patients with longer follow-up.