Spine
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A retrospective review of patients treated at 2 institutions with anterior lumbar interbody fusion using a minimally invasive lateral retroperitoneal approach, and review of literature. ⋯ Current data corroborates and contributes to the existing body of literature describing XLIF outcomes. Procedures are generally performed with short OR times, minimal EBL, and few complications. Patients recover quickly, requiring minimal hospital stay, although transient hip/thigh pain and/or weakness is common. Long-term outcomes are generally favorable, with maintained improvements in patient-reported pain and function scores as well as radiographic parameters, including high rates of fusion.
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Literature review, technique overview, prospective and retrospective data analysis. ⋯ Current decompression techniques may result in inadequate decompression of the neural foramen or excessive resection of the facet joint. MIS decompression using a flexible microblade shaver system represents a way to perform an effective, facet-preserving decompression for patients with lumbar spinal stenosis.
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Review of the literature with analysis of pooled data. ⋯ As spine surgery, and patient comorbidity, becomes increasingly complex, IOM permits more aggressive deformity correction and tumor resection. Combination of SSEP and MEP monitoring provides assessment of entire spinal cord functionality in real time. Spontaneous and triggered electromyography add assessment of nerve roots. The wake-up test can continue to serve as a supplement when needed. MIOM may prove useful in preservation of neurologic function where an alteration of approach is possible. IOM is a valuable tool for optimization of outcome in complex spinal surgery.
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Literature review. ⋯ An appropriate SOC as it relates to neuromonitoring is difficult to devise because of national variance with regard to qualifications of neurophysiologic technical and professional personnel, different levels of training and certification, and anesthesia protocols. A unified group of surgeons working in collaboration with a multidisciplinary group of experienced doctoral level nonphysician and physician professional surgical neurophysiologists is needed to define a protocol for providing and interpreting such data. In addition to ensuring that only the most qualified and experienced personnel are delivering and/or interpreting neuromonitoring services, surgeons, hospital administrators, and insurance company medical directors need to understand the different service delivery models and their respective strengths and limitations with particular attention to the qualifications and competencies of all respective parties. Only then can a well-defined SOC be established, thus improving the treatment of surgical patients for whom neuromonitoring is required.