International journal of spine surgery
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The minimum clinically importance difference (MCID) represents a threshold for improvements in patient-reported outcomes (PROs) that patients deem important. No previous study has comprehensively examined risk factors for failure to achieve MCID after anterior cervical discectomy and fusion (ACDF) procedures for radiculopathic symptomatology. The purpose of this study is to determine risk factors for failure to reach MCID for Neck Disability Index (NDI), Visual Analog Scale (VAS) neck pain, and VAS arm pain in patients undergoing 1- or 2-level ACDF procedures. ⋯ 3.
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Given the paucity of literature regarding compensatory mechanisms used by obese patients with sagittal malalignment, it is necessary to gain a better understanding of the effects of obesity on compensation after comparing the degree of malalignment to age-adjusted ideals. This study aims to compare baseline alignment of obese and nonobese patients using age-adjusted spino-pelvic alignment parameters, describing associated spinal changes. ⋯ Clinical evaluation should extend to the cervical spine in obese patients not meeting age-adjusted sagittal alignment ideals.
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Full-body stereographs for adult spinal deformity (ASD) have enhanced global deformity and lower-limb compensation associations. The advent of age-adjusted goals for classic ASD parameters (sagittal vertical axis, pelvic tilt, spino-pelvic mismatch [PI-LL]) has enabled individualized evaluation of successful versus failed realignment, though these remain to be radiographically assessed postoperatively. This study analyzes pre- and postoperative sagittal alignment to quantify patient-specific correction against age-adjusted goals, and presents differences in compensation in patients whose postoperative profile deviates from targets. ⋯ 3.
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The objective of this study is to analyze incidence, estimate cost savings, and evaluate best management practices of complications resulting from outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis performed in an ambulatory surgery center. ⋯ Complications after outpatient transforaminal endoscopic decompression surgery with respect to reherniation, wound infections, durotomy, and nerve root injury are approximately 1 magnitude lower than equivalent reported complication rates with microdiscectomy while delivering comparable clinical outcomes and lower readmission rates to an emergency room or hospital. Postoperative sequelae are typically self-limiting and successfully managed with supportive care measures. Significant cost savings are realized due to a considerably lower rate of decompensated postoperative medical problems.
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Standard fluoroscopic navigation and stereotactic computed tomography-guided lumbar pedicle screw instrumentation traditionally relied on the placement of Kirshner wires (K-wires) to ensure accurate screw placement. The use of K-wires, however, is associated with a risk of morbidity due to potential ventral displacement into the retroperitoneum. We report our experience using a computer image-guided, wireless method for pedicle screw placement. We hypothesize that minimally invasive, wireless pedicle screw placement is as accurate and safe as the traditional technique using K-wires while decreasing operative time and avoiding potential complications associated with K-wires. ⋯ Wireless, percutaneous placement of lumbar pedicle screws using computed tomography-guided stereotactic navigation is a safe, reproducible technique with very high accuracy rates.