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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Randomized Controlled Trial
Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy.
The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. ⋯ A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.
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Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and/or progressive symptoms of spinal canal compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage into synovial cysts have been reported in the literature.
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Case Reports
Incarcerated herniation of the cervical spinal cord after laminectomy for an ossification of the yellow ligament.
A 74-year-old man showed a spastic gait and myelopathy in both the hands. Computed tomography revealed an OPLL on C3 and C4, bony spurs on the dorsal side of C4-C6, and an OYL on C3 and C4. We scheduled a two-stage decompression for both the OPLL and OYL. ⋯ The patient's myelopathy gradually improved. There have been no reports on postoperative neurological deterioration caused by spinal cord herniation associated with a dural defect at the laminectomy site, without dural tear in the surgery after the resection of a posteriorly located cervical OYL. The possibility of a dural defect in OYL cases should be considered when planning a laminectomy for the resection of the OYL.
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New spinal implants and surgical procedures are often tested pre-clinically on human cadaver spines. However, the availability of fresh frozen human cadaver material is very limited and alternative animal spines are more easily available in all desired age groups, and have more uniform geometrical and biomechanical properties. The porcine spine is said to be the most representative model for the human spine but a complete anatomical comparison is lacking. ⋯ The size of the end-plates increased more caudally in the human spine. Relating the dimensions to the size of the vertebral body, similarities were found in the size of the spinal canal, the transverse processus length, and size of the pedicles. Taking scaling differences into account, it is believed that the porcine spine can be a representative anatomical model for the human spine in specific research questions.
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Currently, there are over 300,000 lumbar discectomies performed in the US annually without an objective standard for patient selection. A prospective clinical outcome study of 200 cases with 5-year follow-up was used to develop and validate an MRI-based classification scheme to eliminate as much ambiguity as possible. 100 consecutive lumbar microdiscectomies were performed between 1992 and 1995 based on the criteria for "substantial" herniation on MRI. This series was used to develop the MSU Classification as an objective measure of lumbar disc herniation on MRI to define "substantial". ⋯ The most frequent types of herniation selected for surgery in each series were types 2-B and 2-AB, suggesting the combined importance of both size and location. The MSU Classification is a simple and reliable method to objectively measure herniated lumbar disc. When used in correlation with appropriate clinical findings, the MSU Classification can provide objective criteria for surgery that may lead to a higher percentage of good to excellent outcomes.