Journal of spinal disorders & techniques
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J Spinal Disord Tech · Apr 2002
Case ReportsBilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following intubation with a double-lumen endotracheal tube for thoracoscopic anterior spinal release and fusion in a patient with idiopathic scoliosis.
Recently, thoracoscopic approaches to the spine have taken on greater clinical applications in the treatment of spinal deformity with generally good results. However, the steep learning curve must be ascended by the surgeon and may lead to complications early in one's experience. There also exists a learning curve for the anesthesiologist to become adept at obtaining single lung ventilation and managing this throughout the operative procedure. ⋯ The patient remained on the ventilator for 24 hours and was extubated without sequelae. Complications from a thoracoscopic approach to the spine for deformity are most often attributed to the learning curve of the surgeon; however, the entire operative team becomes exposed to the challenges of performing this procedure. This report documents a life-threatening complication of air throughout the chest, mediastinum, abdomen, and subcutaneous tissues in a patient with severe scoliosis.
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J Spinal Disord Tech · Apr 2002
Surgical management of lumbar degenerative spinal stenosis with spondylolisthesis via posterior reduction with minimal laminectomy.
Degenerative lumbar spondylolisthesis with spinal stenosis is commonly treated with laminectomy. Recent reports have consistently supported the incremental clinical benefit of associated in situ arthrodesis with or without instrumentation. Resection of the lamina may result in intraoperative dural tear or epidural scar formation. ⋯ Late imaging was available a mean of 28 months after operation. Clinical and imaging analyses and Oswestry scoring confirmed results comparable to the published outcomes of in situ fusion after formal laminectomy. Resection of the lamina may not be necessary in the treatment of degenerative lumbar spinal stenosis with spondylolisthesis.
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J Spinal Disord Tech · Feb 2002
Multicenter StudyPersistent low back pain and sciatica in the United States: treatment outcomes.
Patients with persistent low back pain (LBP) appear to be different in several important ways from patients who have traditionally been classified as patients with acute or chronic LBP, and data on the effectiveness of the treatments prescribed for them are lacking. The aim of the current study was to evaluate the short- and long-term effectiveness of the treatments currently prescribed for these patients. The data reported in this article were gathered as part of a multicenter, prospective, cross-sectional study of patients who were treated for persistent LBP by neurologic and orthopedic surgeons who are recognized specialists in spinal disorders. ⋯ The outcome of surgery for persistent LBP varied from dramatic for one subgroup of surgical patients, to poor for another subgroup of patients. Patients who were selected immediately for surgical treatment improved substantially. Those treated surgically later by study physicians or by physicians not associated with the study fared less well.
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J Spinal Disord Tech · Feb 2002
Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results.
A prospective analysis of consecutive cases of lumbar fusion using the unilateral transforaminal posterior lumbar interbody fusion (TLIF) technique with pedicle screw fixation. The objective of the study was to assess the clinical and radiographic outcome of TLIF and describe the technique and indications in the treatment of degenerative disease of the lumbar spine. Forty patients treated with TLIF for degenerative diseases of the lumbar spine were followed up for a minimum of 2.5 years (mean: 36 months; range: 30-42 months). ⋯ Thirty-six (90%) had solid fusions radiographically at latest follow-up. Seventy-nine percent had excellent or good clinical outcomes. Our patients demonstrated high fusion rates and patient satisfaction.