Spine
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A nonlinear three-dimensional finite element model of the osteoligamentous L3-L4 motion segment was used to predict changes in posterior element loads as a function of disc implantation and associated surgical procedures. ⋯ The models suggest that, by altering placement of the artificial disc in the anteroposterior direction, a surgeon can modulate motion-segment flexuralstiffness and posterior load-sharing, even though the specific disc replacement design has no inherent rotational stiffness.
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A retrospective review of all patients surgically treated by a single surgeon with a three-level anterior cervical discectomy and fusion with and without anterior plate fixation. ⋯ The addition of plate fixation for three-level anterior cervical discectomy and fusion is a safe procedure and does not result in higher complication rates. In this study, the pseudarthrosis rate was lower for patients with a cervical plate. However, this difference was not statistically significant. Patients treated with cervical plating had overall better results when compared with those of patients treated without cervical plates. Although the use of cervical plates decreased the pseudarthrosis rate, a three-level procedure is still associated with a high nonunion rate, and other strategies to increase fusion rates should be explored.
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A review of the literature concerning the use of interbody fusion devices and materials in anterior cervical surgery. ⋯ There is limited evidence supporting the use of a cervical interbody fusion device in place of autologous bone. There is a need to standardize the testing of implants with good quality laboratory work preceding clinical use. Certain devices including cages, some forms of hydroxyapatite, and bone morphogenic proteins merit further study.
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Randomized Controlled Trial Clinical Trial
Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine.
Prospective, randomized, double-blind study. ⋯ Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.
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A study of five patients whose dumbbell or paraspinal tumors of the thoracic spine were managed by using thoracoscopic surgery is reported. ⋯ Combined laminectomy and thoracoscopic surgery may be a good alternative method for managing thoracic dumbbell tumors.