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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To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. ⋯ Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.
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Observational Study
Prediction of walking ability following posterior decompression for lumbar spinal stenosis.
Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. ⋯ Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.
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This study aimed to quantify osteotomy protocol for severe spinal deformity correction based on pre-operative demographic, clinical and radiologic parameters. ⋯ This study showed that osteotomy plan of severe spinal deformity could be determined as follows: Firstly, Ponte/2 + PSO/3 and BDBO/4 + SVCR/5 + MVCR/6 groups can be divided by either T-DAR (cutoff = 28) or the Cobb angle of pre-operative maximum kyphosis (cutoff = 100). Secondly, Ponte/2 + PSO/3 group could be further dichotomized into Ponte/2 and PSO/3 by age (cutoff = 18). Finally, BDBO/4 + SVCR/5 + MVCR/6 group could be divided into BDBO/4 + SVCR/5 and MVCR/6 groups by S-DAR (cutoff = 20).
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This study aims to introduce an innovative adjustable prone positioning frame (APPF) and explore its feasibility and safety for treatment of severe kyphosis secondary to ankylosing spondylitis (AS) with two-level osteotomy. ⋯ The innovative APPF provided great convenience to place patients with severe kyphosis secondary to AS in a prone position. Performing two-level osteotomy with the aid of APPF is safe, feasible and effective.
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Sedimentation sign was reported to have high sensitivity and specificity for diagnosis of lumbar spinal stenosis (LSS). We aimed to determine cerebrospinal fluid signal loss (CSFSL) at the intervertebral disc levels in the sagittal plane using a numerical scoring system and to evaluate the diagnostic value of this method in differential diagnosis of LSS and non-specific low back pain (LBP) and compare it with SS. ⋯ CSFSL sign might be used to distinguish LSS from LBP and unlike SS it is successful in moderate stenosis.