Journal of spine surgery (Hong Kong)
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Revision spinal surgery following primary spinal fusion procedure occurs in 8-45% of cases. Reasons for revision include recurrence of stenosis, non-union, implant failure, infection, adjacent segment degeneration and flat back fusion. With the rise in elective lumbar fusion rates, it is expected that the rate for revision spinal surgery will also increase with time. The use of minimal invasive surgical techniques for revision spinal surgery is controversial. Careful patient and technique selection is important in achieving satisfactory outcome in revision spinal surgery. ⋯ Our proposed algorithm provides surgeons with a systematic approach in selecting the appropriate combination of MIS techniques for revision lumbar spinal surgery based on pathology and sagittal alignment.
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Anterior cervical discectomy and fusion (ACDF) is well-tolerated by most patients and commonly necessitates only a short hospital admission. Surgical delay after hospital admission, however, may result in longer hospital stays, consequently increasing hospital resource utilization. The current study evaluates risk factors for surgical delay in patients undergoing elective ACDF. ⋯ 3.
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Multimodal analgesia (MMA) involves the use of additive or synergistic combinations of analgesics to achieve clinically required analgesia while minimizing significant side effects associated with higher dose of a single equianalgesic medication such as an opioid analgesic. MMA generally involves optimizing non-opioid pharmacologic and non-pharmacologic interventions and reserving opioid use to treat breakthrough pain. ⋯ Successful implementation of a MMA requires the input and cooperation of all of the stakeholders including the caregivers as well as the patients. Health system benefits can also be realized from the implementation of an effective MMA, as fewer opioid related side effects can improve patient recovery and lead to faster discharge and improved utilization of resources.
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Chemonucleolysis is a minimally invasive treatment for cervical and lumbar intervertebral disc herniation (IDH). While this procedure has existed for more than 50 years, it has yet to become an established practice. ⋯ Although two enzymes (chymopapain and collagenase) have been used in clinical settings, severe adverse events have discouraged widespread use. The recently introduced enzyme Proteus vulgaris chondroitin sulfate ABC endolyase may allow a new era of chemonucleolysis because of its high specificity for NP.
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Management of spine fractures has advanced considerably even over the past decade. A review of the current and historical literature can lead to a better appreciation of current management protocols. This is the first comprehensive review of the most influential articles related to spine fracture management. The purpose of this study is to identify and analyze the 100 most cited publications in spine fracture management. ⋯ Despite less time for citation than other decades, the 2000s contain the plurality of the influential publications. This may indicate that some of the most important changes to spine fracture management pertain to improved imaging modalities and surgical technologies. This review provides a guide for a comprehensive understanding of the historical and current literature pertaining to spine fracture management.