Journal of neurosurgery. Spine
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In this paper the authors sought to determine the segmental lumbar sagittal contour change after bilateral transforaminal lumbar interbody fusion (TLIF). ⋯ A significant improvement in lumbar lordosis can be gained by preforming bilateral facetectomies in TLIF with posterior compression. This procedure provides an additional option to a spine surgeon's armamentarium in dealing with significant lumbar sagittal plane deformities.
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Incidental durotomies (IDs) are an unfortunate but anticipated potential complication of spinal surgery. The authors surveyed the frequency of IDs for a single spine surgeon and analyzed the major risk factors as well as the impact on long-term patient outcomes. ⋯ The authors established a reliable baseline incidence for durotomy after spine surgery: 3.5%. They also identified risk factors that can increase the likelihood of a durotomy, including location of the spinal procedure, type of procedure performed, and the implementation of a new procedure. The years of physician training or resident experience did not appear to be a major risk for ID.
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Spinopelvic parameters in children with achondroplasia have not been described. Because they observed a unique sagittal spinopelvic phenotype in some achondroplastic children with very horizontal sacrums, the authors sought to quantify the spinopelvic parameters in a pediatric patient population. ⋯ Spinopelvic parameters in achondroplasia are potentially dichotomous. The future implications of this observation are not known and will need to be explored in future long-term studies that follow pediatric patients with achondroplasia through adulthood.
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Spinal metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar spine metastasis. ⋯ Minimally invasive treatment of thoracolumbar spine metastasis is a safe and effective palliative option in patients with limited life expectancy, to limit morbidity and preserve quality of life.