Spine
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A literature review and synthesis were performed. ⋯ Intraspinal medication delivery has become an effective technique for control of intractable pain in appropriately selected patients seen by spine surgeons.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2.
A prospective, nonblinded, multicenter study of outcomes in patients undergoing single-level anterior lumbar discectomy and interbody fusion with InFUSE Bone Graft. ⋯ The use of InFUSE Bone Graft is a promising method of facilitating anterior intervertebral spinal fusion, decreasing pain, and improving clinical outcomes in patients who have undergone anterior lumbar fusion surgery with structural threaded cortical allograft bone dowels.
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Motor-evoked potentials from the external anal sphincter were analyzed using transcranial electrical stimulation during spinal surgery in patients under general anesthesia. ⋯ The results suggest that, using a transcranial multipulse stimulation, monitoring of motor-evoked potentials from the external anal sphincter is feasible during ketamine- and propofol-based anesthesia. However, further improvement of techniques would be required for intraoperative elicitation of motor-evoked potentials from the external anal sphincter.
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Comparative Study
Biomechanical comparison of lumbosacral fixation techniques in a calf spine model.
biomechanical testing of the strength and stability of lumbosacral fixation constructs. ⋯ This study demonstrates the effectiveness of adding a second fixation point distal to the S1 screws in reducing S1 screw strain. Iliac fixation is more effective than secondary sacral fixation points but may not be necessary in all clinical situations. Only iliac fixation effectively increased the load to failure under catastrophic loading conditions. Supplementary sacral fixation failed to significantly protect against catastrophic failure. These findings support the clinical observation that iliac fixation is least likely to fail in high-risk, long fusions. Whether testing range of motion, screw strain, or load to failure, no benefit could be demonstrated for intrasacral rod placement when compared with other supplementary sacral fixation techniques. Intrasacral rod placement was equal to a second sacral screw in reducing S1 screw strain during flexion-extension loading. It was not as effective as iliac fixation in reducing screw strain or preventing catastrophic failure. When choosing fixation methods in long fusions to the sacrum, this study supports the use of iliac fixation as the method least likely to loosen or pull out. A second point of sacral fixation also offers biomechanical advantages when compared with S1 fixation alone and may be an appropriate choice in less "high risk" fusions to the sacrum.
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Comparative Study
The feasibility of anterior thoracoscopic spine surgery in children under 30 kilograms.
A retrospective comparison of pediatric patients weighing less than 30 kg who underwent thoracoscopic anterior spinal release and fusion for deformity correction. This group was compared to two control groups: patients weighing over 30 kg (thoracoscopic) and patients under 30 kg (open). ⋯ Despite the decreased working space within the chest and difficulties of selective intubation, anterior thoracoscopic surgery for spinal release and fusion can be performed as safely in "small" children as in "large" children; however, additional intraoperative challenges should be anticipated. Although the outcomes were similar in the small thoracoscopic children compared to the small open children, the authors believe that very small patients (under 20 kg) should remain a relative contraindication to thoracoscopic surgery, especially during a surgeon's learning curve.