Spine
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Clinical Trial
Impact of surgical intervention on quality of life in patients with spinal metastases.
Prospective clinical study. ⋯ Surgery for patients with spinal metastases offers decreased pain and improved quality of life with low rates of surgical complications.
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Cadaveric study. ⋯ The majority of specimens can safely accept placement of a laminar screw. This study establishes anatomic guidelines to allow for accurate screw selection and insertion. Preoperative planning is essential for safe screw placement via this technique.
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A total of 709 skeletally mature atlas specimens were obtained from the Hamann Todd Collection at the Cleveland Museum of Natural History. Using digital caliper, the thickness of the vertebral artery groove was measured to determine the feasibility of potential screw placement. ⋯ Our results suggest that although only a small percentage of patients can accept a screw that is directly inserted via the posterior-lateral arch into the lateral mass, the notching technique is possible in the vast majority of patients. To our knowledge, this is the largest study to examine the possibility of using the posterior-lateral arch as the starting point for these screws. Our results suggest that alternative starting points for these screws are possible in a large percentage of the cases.
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Patient surveys to determine preferences in surgical decision making. ⋯ Spine surgical patients often prefer to defer surgical decision making to their surgeons. In clinical scenarios where there is little controversy and the evidence is clear, this results in little consequence, assuming that the surgeon aims to provide evidence-based care. In scenarios with greater controversy and less clear evidence, the choice of treatment offered by the surgeon may be based on factors outside of the available science, and, accordingly, efforts should be made to educate fully the patient and to help the patient make his/her own decision based on personal values regarding outcomes.
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Case report. ⋯ When faced with a patient with a history of multiple hereditary exostoses with new onset of myelopathic symptoms and a mass compressing the spinal cord, the clinician's differential should be broad and always initially include a metastatic lesion, osteochondroma, or chondrosarcoma.