Journal of neurosurgery. Spine
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Comparative Study
Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage.
An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. ⋯ Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.
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Meta Analysis
Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies.
The authors performed exploratory meta-analyses of observational cohort studies, evidence level III, examining whether earlier surgery makes a difference in outcome in terms of urinary function once cauda equina syndrome (CES) from a herniated lumbar disc has progressed to urinary retention (CESR). ⋯ This study supports early surgery for CES and indicates that CESR and CESI cases should not be analyzed together.
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The authors report the first description since 1957 of a lumbar disc herniation as a cause of stump pain. Most amputees frequently experience stump pain or phantom pain. The pathophysiology of phantom pain is not clearly defined; however, there are well-defined reasons for stump pain such as infection, tissue necrosis, hematoma, wound breakdown, bone spur, neuroma, and so on. During the differential diagnosis, radiculopathy due to lumbar disc herniation must also be evaluated.
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Despite the growing use of multimodal intraoperative monitoring (IOM) in cervical spinal surgery, limited data exist regarding the sensitivity, specificity, and predictive values of such a technique in detecting new neurological deficits in this setting. The authors sought to define the incidence of significant intraoperative electrophysiological changes and new postoperative neurological deficits in a cohort of patients undergoing cervical surgery. ⋯ Combined neurophysiological IOM with EMG and SSEP recording and the selective use of MEPs is helpful for predicting and possibly preventing neurological injury during cervical spine surgery.
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The objective in this study was to compare retrospectively the use of different operating tables with different positions for posterior lumbar interbody fusion (PLIF) and the effect on intraoperative and postoperative lumbar lordosis and segmental lordosis. ⋯ Intraoperative position does not affect postoperative total lumbar lordosis and segmental lordosis in short-segment PLIF of the lumbar spine in a retrospective analysis of the surgical procedure to maintain lordosis.