European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This study was designed to develop predictive models for surgical outcome based on information available prior to lumbar stenosis surgery. Forty patients underwent decompressive laminarthrectomy. Preop and 1-year postop evaluation included Waddell's nonorganic signs, CT scan, Waddell disability index, Oswestry low back pain disability questionnaire, low back outcome score (LBOS), visual analog scale (VAS) for pain intensity, and trunk strength testing. ⋯ Underlying subclinical vascular factors may be involved in the complaints of spinal stenosis patients. Those factors should be investigated more thoroughly, as they may account for some of the failures of surgical relief. The CHAID decision tree appears to be a novel and useful tool for predicting the results of spinal stenosis surgery
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Clinical Trial
Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine.
Posterior instrumentation of the cervical spine has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervico-thoracic junction, has led spine surgeons to use pedicle screws. The improved biomechanical stability of pedicle screws and transarticular C1/2 screws allows for shorter instrumentations and improves the repositioning possibilities. ⋯ The mean operation time was 144 min (90-240 min) and the mean blood loss was 234 ml (50-800 ml). C1/2 transarticular screws, as well as transpedicular screws in the cervical spine and the cervico-thoracic junction, can be applied safely and with high accuracy using a CAS system. Computer-assisted instrumentation is recommended especially for pedicle screws at C3-C6.
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Deep vein thrombosis (DVT), and its most feared complication, pulmonary embolism (PE), still have a high incidence with high risk for patients' health. Proven prophylactic measures are available but are generally underused, and DVT is still considered the most common cause of preventable death among hospitalized patients. The rationale for prophylaxis of venous thromboembolism is based on the clinically silent nature of the disease, the relatively high prevalence among hospitalized patients and the potentially tragic consequences of a missed diagnosis. ⋯ The incidence of DVT during spine surgery is not documented in the literature, because only case reports or retrospective studies are reported. It would therefore be very helpful to initiate a multicenter study in order to understand this problem better and to develop, if possible, some guidelines on prophylactic measures in spine surgery. In doing so, we need to consider each patient's pattern, any risk factors and every kind of surgical technique related to DVT, in order to improve the outcome of the patient and to reduce any medicolegal problems that could arise from a thrombotic complication or an epidural hematoma, with its high potential for irreversible consequences.