Spine
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Comparative Study
Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity.
Observational cohort study. Retrospective review of prospectively collected outcomes data. ⋯ MIS decompression alone for leg dominant symptoms is a clinically effective procedure in the majority of patients including those with degenerative spondylolisthesis or scoliosis. However, patients with scoliosis, particularly those with lateral listhesis, have a significantly higher revision rate that needs to be considered in operative decision-making.
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Epidemiological study using national administrative data. ⋯ At least 85% of principal procedures using BMP were for off-label applications. With uncertainty regarding the risks of using BMP in certain off-label applications, further research will be needed to better define the appropriate indications. Our study also demonstrates that disparities in the differential rates of BMP use exist in the spine fusion population.
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Comparative Study
The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison.
A cadaveric simulation model of the lumbar spine was used to study the intervertebral motion characteristics of the lumbar spine after bilateral laminotomy and facet-sparing laminectomy. ⋯ These data demonstrate that bilateral laminotomies induce significantly less hypermobility and less stiffness reduction compared with a full laminectomy. The preservation of the central posterior osteo-ligamentous structures may provide a stabilizing effect in preventing postdecompression spondylolisthesis.
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Case-control propensity matched. ⋯ After controlling for covariates known to affect outcomes after lumbar fusion, patients on workers' compensation have significantly less improvement of clinical outcomes in both mean change in ODI and SF-36 PCS, as well as the number of patients achieving substantial clinical benefit. The improvement in back pain was similar between the two groups, but patients on workers' compensation remained more disabled after lumbar fusion. Differences in outcomes may be related to unidentified covariates associated with workers' compensation status.
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Retrospective review. ⋯ Preoperative placement of radiopaque markers at the level of interest before surgery of the thoracic spine is a safe and effective technique for avoiding wrong-level surgery in cases in which standard localization techniques may be difficult.