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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A recurrent lumbar disc herniation (RLDH) is the most prevalent cause for new radicular pain after surgery for disc herniation-induced sciatica. Reported risk factors include age, gender and smoking, while its surgical treatment is associated to a higher rate of complications and costs. The purpose of this study is to identify factors that increase the risk of requiring surgical treatment for a first RLDH in workers' compensation patients. ⋯ A subligamentous disc herniation and patient's age inferior to 35 years at the time of the first surgery are risk factors for requiring surgical treatment of a first RLDH among workers' compensation patients.
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Biomechanical analysis of Ponte (PO) and pedicle subtraction osteotomies (PSO) in kyphotic deformity instrumentation. ⋯ Multi-level PO allows similar kyphotic correction to 1-level PSO in spinal deformities with mixed indications for PO and PSO. Loads on the instrumentation constructs in PSO were higher than multi-level PO and higher in 6-level PO than 3-level PO. High loads were located more on the osteotomy sites. The rod shape should be adapted to the anticipated spine correction on the osteotomy sites.
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We present a retrospective study of patients with multilevel contiguous tuberculous spondylitis of thoracic region that underwent single-stage posterolateral debridement and fusion and following posterior instrumentation. ⋯ One-stage surgical treatment for multilevel contiguous spinal tuberculosis by posterolateral debridement, fusion, posterior instrumentation can be an effective and feasible treatment method.
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A decompensated sagittal imbalance has been associated with worsening health-related quality of life outcomes and increasing pain. Significant improvement in sagittal balance can be achieved using a pedicle subtraction osteotomy (PSO); however, this procedure has a high complication profile. A lumbar PSO has the advantages of direct visualization of all neural structures and safer retraction of the thecal sac. Sacrificing neuromonitoring may reduce anaesthesia time and lead to improved cost effectiveness of the surgery. However, there are no studies analyzing the complication rate of lumbar PSO without the use of neuromonitoring. We hypothesize that the neurologic complication rate remains comparable to published studies even without the use of intraoperative neuromonitoring. ⋯ Historically, PSOs are associated with a high surgical complication rate and our results show comparable outcomes and complications to those previously reported. In our series, the absence of neuromonitoring in lumbar PSOs does not appear to increase the risk of neurological injury.
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A report of two cases with complex cervical spondylotic myelopathy (CSM) and review of the literature. ⋯ Posterior surgical approach as C1-7 laminectomy with fixations or occipital-cervical fusions may obtain better reconstructions of the cervical spine and good neurological recovery for the patients with complex CSM we present. However, the incidence and ethnic predisposition for the patients with complex CSM are still unclear.