J Neurosurg Sci
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Surgical approaches to the thoracic spine have evolved in recent decades with the development of advanced instrumentation techniques and an increased emphasis on reducing surgical morbidity. Multiple methods to access this area have been described, from a conventional open to a more minimally invasive approach, such as anterior-based, via supra- or transmanubrium, via thoracoscopy, lateral-based approach, extreme lateral mini-thoracotomy, and dorsolateral approaches, transpedicular, costotransversectomy and the lateral extracavitary access. The technique used is often determined by the affected spinal level, pathological process, and surgeon preference. ⋯ Over time, these techniques have undergone improvement to limit approach-related morbidity and minimize soft tissue dissection, resulting in better patient outcomes. These different approaches present distinct advantages and disadvantages for which a thorough understanding of the regional anatomy is required to avoid approach-related complications. For these reasons, surgeon experience and confidence in the various techniques are major factors in the decision-making process and patient outcomes.
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Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. ⋯ There are no studies done on the subject MIS and low back pain solely. Deriving answers from the difference in VAS back pain in MIS studies reveal a 100% improvement of back pain after surgery. But that does not imply that this procedure, which is still in its childhood, will be the solution to all low back pain patients.
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The aim of this paper was to provide a comprehensive review of literature regarding the classification systems and surgical management of thoracolumbar spine trauma. ⋯ There is still much controversy over the surgical management of various thoracolumbar fractures. Level I data exists supporting the nonsurgical management of thoracolumbar burst fractures without neurologic compromise. However, for the majority of fracture types in this region, more randomized controlled trials are necessary to establish standards of care.
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Postoperative spinal patients remain a challenge for provision of postoperative analgesia. They often exhibit tolerance to narcotics, which requires alternative agents. Our institution has an experience with the use of dexmedetomidine for postoperative analgesia in spine patients. ⋯ Dexmedetomidine represents an important agent for the treatment of severe postoperative spinal pain as a supplemental agent with patients that do not achieve adequate analgesia from narcotics.
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In this study, we are using a recently developed method: a minimally invasive retractor system and an operating microscope to treat far lateral lumbar herniated disc. This method decreases tissue dissection and blood loss, and improves postoperative recovery. ⋯ This technique combines the advantages of endoscopic surgery and microscope guided surgery (3D vision) and provides good functional results in this study.