Journal of neurosurgery. Spine
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The elderly compose a substantial proportion of patients presenting with complex spinal pathology. Several recent studies have suggested that fusion of 4 or more levels increases the risk of perioperative complications in elderly patients. Therefore, the purpose of this study was to analyze the effects of age in persons undergoing multilevel (> or = 5 levels) thoracolumbar fusion surgery. ⋯ Age is a positive risk factor for major postoperative complications in extensive thoracolumbar spinal fusion surgery. Complication rates in the elderly are high, and good clinical judgment and careful patient selection are needed before performing extensive thoracolumbar reconstruction in older persons.
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Randomized Controlled Trial Multicenter Study Comparative Study
Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial.
Patients with radiculopathy, with or without back pain, often do not respond to conservative care and may be considered for epidural steroid injection therapy or a disc decompression procedure. Plasma disc decompression (PDD) using the Coblation SpineWand device is a percutaneous, minimally invasive interventional procedure. The purpose of this study was to evaluate clinical outcomes with PDD as compared with standard care using fluoroscopy-guided transforaminal epidural steroid injection (TFESI) over the course of 2 years. ⋯ In study patients who had radicular pain associated with a contained lumbar disc herniation, those patients treated with PDD had significantly reduced pain and better quality of life scores than those treated using repeated TFESI. In addition, significantly more PDD patients than TFESI patients avoided having to undergo a secondary procedure during the 2-year study follow-up.
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Tumors involving the spine have unique associated neurological symptoms. The occurrence of spine-related symptoms has been shown to predict treatment course and survival in several studies conducted in patients with solid tumors and consequent spinal cord dysfunction. Currently, no instrument that measures both neurological and cancer-related symptoms exists for patients with spine tumors. The objective of this study was to develop a reliable and valid self-reporting instrument for patients with spine tumors. ⋯ The 18-item MDASI-SP demonstrated validity and reliability in patients with spine tumors as a composite measure of disease-related symptoms. This instrument can be used to describe symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.
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Modic changes (MCs) and high-intensity zones (HIZs) potentially serve as variably sensitive markers for discogenic chronic low-back pain (CLBP). No study has hitherto assessed the phenomenon of MC-HIZ coexistence at a single level, and the goal in this study was to assess the nature and frequency of this phenomenon. ⋯ In patients with discogenic CLBP associated with HIZ or MC lesions, MC-HIZ coexistence at 1 level was significantly rarer than expected even by chance; thus, despite both being manifestations of a seemingly common degenerative process, HIZ and MC more closely represent "either/or" phenomena. Because HIZ disc height was significantly greater, HIZs may develop earlier in the disc degenerative ontogeny. If any degenerative disc may only display an HIZ first, yet may ultimately display an MC instead, then HIZs must invariably regress as MCs supervene (or even vice versa). The MC-HIZ coexistence would therefore represent either a rare stable state (possibly more common in females) or a transitory state, as one lesion gradually replaces the other. Longitudinal studies would confirm or refute these hypotheses, although significantly larger sample sizes would be required.
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Case Reports
Cervical cord compression due to delayed scarring around epidural electrodes used in spinal cord stimulation.
The authors report on 2 cases of delayed compression of the cervical spinal cord by dense scar tissue forming around epidural electrodes implanted for spinal cord stimulation (SCS). This complication has not been previously reported. Myelopathy developed in 2 patients 5 and 16 years after the surgical placement of a cervical epidural electrode. ⋯ Both patients experienced a full recovery following the removal of both scar tissue and the electrode. Medical and paramedical staff dealing with SCS should be aware of this severe and delayed complication. In addition, the development of epidural fibrosis can explain the occurrence of tolerance.