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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The authors have developed a "para-midline" approach to the posterior lumbar spine using a virtually avascular surgical plane not previously described in the literature. It was their purpose to document consistent MRI presence of this plane and to prospectively evaluate its clinical use in terms of blood loss. ⋯ The para-midline approach for lumbar surgery is associated with less blood loss than traditional, subperiosteal exposure techniques. The fatty interval through which this approach is made is universally present and identifiable on MRI. The authors offer this approach as a means of decreasing the risks associated with blood loss and transfusion with posterior lumbar surgery.
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Multicenter Study
Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors.
A prospective, longitudinal cohort was studied to determine the incidence, consequences, and risk factors of major perioperative complications in patients with cerebral palsy (CP) treated with spinal fusion. There is a wide variety of data available on the complications of spine surgery; however, little exists on the perioperative complications in patients with CP. ⋯ 2.
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Review Multicenter Study
A multicentre retrospective review of muscle necrosis of the leg following spinal surgery with motor evoked potential monitoring: a cause for concern?
There are very few reported cases of compartment syndrome of the leg following spinal surgery via a posterior approach. An association between compartment syndrome and muscle over-activity via nerve stimulation during evoked potential monitoring was first suggested in 2003. No further reports have suggested this link. We present a multicentre retrospective review of a series of five patients who developed compartment syndrome of the leg following spinal surgery via a posterior approach, whilst un-paralysed and with combined sensory (SSEP)/motor evoked potential (MEP) monitoring with an aim of highlighting this possible causative factor. ⋯ Previous cases in the literature have related to mal-positioning on the Jackson table or use of the knee-chest position for surgery. This was not the case for our patients; therefore, we suspect an association between overactive muscle stimulation and muscle necrosis. Further experimental studies investigating this link are required.
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Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. ⋯ The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.
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It has been shown that the conus medullaris displaces significantly and consistently in response to both unilateral and bilateral SLRs. Point of interest is represented by whether the magnitude of this displacement can be predicted in asymptomatic subjects. The purpose was to investigate whether any correlations existed between demographic and anthropometric factors and hip flexion angle with magnitude of conus medullaris displacement with the unilateral and bilateral SLR. This was done following the notion that there is the possibility that cord movement may contain aspects of predictability in asymptomatic subjects. ⋯ The data show that in in vivo and structurally intact asymptomatic volunteers, the degree of hip flexion may have strong predictive values for magnitude of neural displacement in response to unilateral and bilateral SLRs. This provides further justification to its quantification in clinical settings. Magnitude of conus medullaris displacement in response to unilateral and bilateral SLRs is not likely to be predicted from easily clinically collectable measures such as age, height, weight and BMI. This study offers information relevant to investigation of prediction of neuromechanical responses in neurodynamic tests.