Spine
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Retrospective review of the medical, radiographic, surgical, and postoperative records of patients who underwent resection of multilevel intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine via a modified paramedian transpedicular approach at the University of California, San Francisco, between 2003 and 2005. ⋯ The modified paramedian transpedicular approach with partial dorsal corpectomy we describe here is a variation of traditional thoracic posterolateral transpedicular extracavitary approaches and offers direct access to lesions of the ventral cervicothoracic spinal canal. This approach avoids the morbidity of anterior transcervical, transoral, or transthoracic procedures, while providing a view of the entire ventral cervicothoracic canal, and can be performed safely and effectively in select patients.
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Retrospective clinical and radiologic evaluation of posterior C1-C2 fusion by transarticular screw (TAS) with morselized autograft and without additional internal fixation. ⋯ Bilateral transarticular screws alone and morselized grafts have high fusion rate in atlantoaxial arthrodesis without instrument failure. TAS fixation could provide stability that is clinically equivalent to the standard screws plus tension band construct as described by Magerl. With anatomic reduction and ideal screw position, additional internal fixation and postoperative collar are not necessary.
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Reanalysis of data derived from longitudinal cohort studies. ⋯ We recommend the 5-item CWOM as a brief clinical measure for whiplash because it is quick to administer and score, and has excellent measurement properties. The CWOM may need to be supplemented with other questionnaires (e.g., when assessment of psychological or emotional health is required).
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Randomized Controlled Trial
Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial.
A randomized, double-blind placebo controlled trial in multimodal analgesia for postoperative pain was conducted. ⋯ Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.
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Randomized Controlled Trial
Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices.
Prospective, randomized, controlled and double-blinded study on imaging of artificial discs. ⋯ Preoperative and postoperative magnetic resonance imaging scans of 20 patients who had undergone cervical arthroplasty were assessed for imaging quality. Five cases each of the Bryan (Medtronic Sofamor Danek, Memphis, TN), Prodisc-C (Synthes Spine, Paoli, PA), Prestige LP (Medtronic Sofamor Danek), and PCM devices (Cervitech, Rockaway, NJ) were analyzed. Six blinded spinal surgeons scored twice sagittal and axial T2-weighted images using the Jarvik 4-point scale. Statistical analysis was performed comparing quality before surgery and after disc implantation at the operated and adjacent levels and between implant types. RESULTS.: Moderate intraobserver and interobserver reliability was noted. Preoperative images of patients in all implant groups had high-quality images at operative and adjacent levels. The Bryan and Prestige LP devices allowed satisfactory visualization of the canal, exit foramina, cord, and adjacent levels after arthroplasty. Visualization was significantly impaired in all PCM and Prodisc-C cases at the operated level in both the spinal canal and neural foramina. At the adjacent levels, image quality was statistically poorer in the PCM and Prodisc-C than those of Prestige LP or Bryan. CONCLUSIONS.: Postoperative visualization of neural structures and adjacent levels after cervical arthroplasty is variable among current available devices. Devices containing nontitanium metals (cobalt-chrome-molybdenum alloys in the PCM and Prodisc-C) prevent accurate postoperative assessment with magnetic resonance imaging at the surgical and adjacent levels. Titanium devices, with or without polyethylene (Bryan disc or Prestige LP), allow for satisfactory monitoring of the adjacent and operated levels. This information is crucial for any surgeon who wishes to assess adequacy of neural decompression and where monitoring of adjacent levels is desired.