Journal of neurosurgery. Spine
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Comparative Study
Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: floating fusion versus distal construct including the sacrum.
The aim of this study was to study the long-term outcomes of patients undergoing instrumented posterior fusion of the lumbar spine. ⋯ In this paper, the authors present one of the largest cohorts in the Western literature of patients undergoing instrumented fusion for degenerative lumbar spine disease. Patients who had floating lumbar fusions were statistically more likely to develop ASD over time than those who had lumbosacral fusions incorporating the S-1 spinal segment, but were less likely to experience postoperative radicular symptoms. Additional prospective studies may more clearly delineate the long-term risks of instrumented posterolateral fusions of the lumbar spine.
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Low-back pain (LBP) is highly prevalent among older adults, and the cost to treat the US Medicare population is substantial. Recent US health care reform legislation focuses on improving quality of care and reducing costs. The sacroiliac (SI) joint is a recognized generator of LBP, but treatments traditionally have included either nonoperative medical management or open SI joint fusion, which has a high rate of complications. New minimally invasive technologies have been developed to treat SI joint disruption and degenerative sacroiliitis, so it is important to understand the current cost impact of nonoperative care to the Medicare program. The objective of this study was to evaluate the medical resource use and associated Medicare reimbursement for patients managed with nonoperative care for degenerative sacroiliitis/SI joint disruption. ⋯ In patients who suffer from LBP due to SI joint disruption or degenerative sacroiliitis, this retrospective Medicare claims data analysis demonstrates that nonoperative care is associated with substantial costs and medical resource utilization. The economic burden of SI joint disruption and degenerative sacroiliitis among Medicare beneficiaries in the US is substantial and highlights the need for more cost-effective therapies to treat this condition and reduce health care expenditures.
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The object of this study was to conduct a prospective, randomized, laboratory investigation of the neuroprotective effects of curcumin functionally, biochemically, and histologically in an experimental acute spinal cord ischemia-reperfusion injury on rabbits. ⋯ Although further studies including different dose regimens and time intervals are required, curcumin could attenuate a spinal cord ischemia-reperfusion injury in rabbits via reducing oxidative products and proinflammatory cytokines, as well as increasing activities of antioxidant enzymes and preventing apoptotic cell death.
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Percutaneous vertebroplasty (PVP) combined with brachytherapy using the interstitial implantation of (125)I seeds has previously yielded encouraging clinical results in the treatment of metastatic vertebral tumors. However, the bone cement injection volume is very small due to the osteolytic damage to the metastatic vertebrae, and the ideal spatial distribution of the (125)I seeds is difficult to achieve. In the current study, the authors present a clinical method for puncture needle insertion to achieve a greater bone cement injection volume and a more ideal spatial distribution of the (125)I seeds. ⋯ The outcomes of PVP combined with multineedle interstitial implantation of (125)I seeds in patients with osteolytic metastatic vertebral tumors appeared to be better than the outcomes of PVP combined with single-needle interstitial implantation of (125)I seeds. These better outcomes may be the result of the greater bone cement injection volume and the more ideal spatial distribution of the (125)I seeds.