Spine
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Randomized Controlled Trial Multicenter Study
Evaluation of surgical volume and the early experience with lumbar total disc replacement as part of the investigational device exemption study of the Charité Artificial Disc.
A prospective, randomized, multicenter, Food and Drug Administration regulated Investigational Device Exemption (IDE) clinical trial. ⋯ Surgeons and institutions with a high volume of lumbar total disc replacement cases have a reduction in key perioperative and postoperative parameters that provide a clinical and/or economic benefit. Surgeons may expect longer hospital stays, higher blood loss, and a higher rate of certain complications in their early experience with total disc replacement procedures, but there was no effect on clinical outcomes.
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Randomized Controlled Trial
Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy.
A prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with bupivacaine or bupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. ⋯ In addition, our data suggest that preemptive infiltration of the wound site with bupivacaine alone provides similar pain control to preemptive infiltration of the wound site with bupivacaine and methylprednisolone combined.
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Author experience and literature review. ⋯ Segmental pedicle screw fixation coupled with one of four posterior osteotomy/resection techniques can be used to address most sagittal plain deformities. Careful application of these techniques is important. Smith-Petersen and Ponte osteotomies are most appropriate for long sweeping deformities with mobile anterior columns. Pedicle subtraction osteotomies and vertebral column resections are most appropriate for fixed, sharply angulated spinal deformities. The successful application of these techniques is dependent on accurate preoperative evaluation of the structural properties of the kyphosis and meticulous execution of the surgical technique.
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Multicenter Study Comparative Study
Comparison of the lowest instrumented, stable, and lower end vertebrae in "single overhang" thoracic adolescent idiopathic scoliosis: anterior versus posterior spinal fusion.
A retrospective multicenter study. ⋯ These data confirm that anterior spinal fusion techniques result in a mean shorter fusion of 1.5 vertebral segments/patient when compared to posterior spinal fusion techniques with respect to the position of the lowest instrumented and stable vertebrae for "single overhang" thoracic (Lenke 1A/B) curves. However, because this is a retrospective multicenter study over 10 years, it represents various posterior spinal fusion techniques that do not include all pedicle screw constructs.
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Author experience and literature review. ⋯ As the magnitude of resection increases, the ability to correct deformity improves, but also the risk of complication increases. Therein, an understanding of potential applications and complications is helpful.