Surgical neurology international
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The purpose of this study was to assess the feasibility of using dual expandable cages plus short segment posterior fixation for reconstruction of vertebral bodies following a mini-open transpedicular approach. ⋯ In select patients requiring circumferential decompression of the lumbar spine, dual cage reconstruction decreases the technical difficulty of the operation and facilitates a mini-open approach. The durability of this construct will need biomechanical assessment and long-term clinical follow-up.
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Cervical foraminotomy is an operation designed to decompress a single or multiple cervical nerve roots from a posterior approach. This type of surgery is an alternative to operations designed to accomplish the same goal from an anterior approach. We describe our experience in patients treated with posterior cervical foraminotomy. ⋯ The posterior cervical foraminotomy is a good option for the treatment of a radicular pain caused by a foraminal conflict.
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When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compensation, and litigation on disability and pain scores. ⋯ This study demonstrates that a history of smoking, workers compensation, and/or litigation, considered alone or worse, combined, negatively impacted outcomes for patients seeking treatment at our spine centers. For optimal outcomes in spine patients, cessation of smoking and treatment of attendant psychological and social factors prove critical.
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Pain relief obtained with spinal cord stimulation (SCS) in failed back surgery syndrome (FBSS) has been shown to be more effective with paddle leads than with percutaneous catheters. A laminectomy is generally required to implant the paddles, but the surgical approach may lead to iatrogenic spinal instability in flexion. In contrast, clinical and experimental data showed that a laminotomy performed through flavectomy and minimal resection of inferior and superior lamina with preservation of the midline ligamentous structures allowed to prevent iatrogenic instability. Aim of the study was to assess degree of instability and pain level in patients operated for SCS through laminectomy or laminotomy with midline structures integrity. The surgical technique is described and our preliminary results are discussed. ⋯ The laminotomy is a minimally invasive approach that ensures rapid recovery after surgery, spinal functional integrity, and complete reversibility. Further studies are needed to confirm our preliminary results.
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Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain. ⋯ Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.