Journal of spinal disorders
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A prospective study was performed in obese and nonobese patients undergoing lumbar spine surgery to report perioperative data and surgical outcomes. One hundred fifty-nine consecutive patients who underwent lumbar spine surgery by a single surgeon entered the study. Among 159 consecutive patients, 55 met the criteria for obesity (> 20% ideal body weight). ⋯ This study found no significant differences between obese and control patients relative to blood loss, operative time, hospital stay, rate of complications, and functional outcome in lumbar spine surgery. Patient selection continues to be the most important factor in terms of operative success. We believe that lumbar spine surgery, including fusion, should not be withheld from obese patients who present with proper indications for surgery and fail an appropriate course of conservative treatment.
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Comparative Study
Radiographic mensuration characteristics of the sagittal lumbar spine from a normal population with a method to synthesize prior studies of lordosis.
Standing lateral lumbar radiographs of 50 normal healthy subjects were retrospectively selected for evaluation of lumbar lordosis. The objective was to evaluate, in a normal population, global and segmental contributions to lordosis in the standing position, and to devise a method to compare the seemingly unrelated multitude of lordotic values in the literature. Because of a variety of positioning and measurement methods of lordosis in live subjects and cadavers, correlation of results is difficult. ⋯ Standing lateral lumbar radiographs of 50 subjects, who had complete histories and normal examinations, were analyzed to determine overall lordosis, segmental contributions, and vertical sagittal alignment. Using posterior body tangents, the mean L1-L5 angle was -39.7 degrees, CobbT12-S1 = -65 degrees, Ferguson's sacral angle = 39 degrees, pelvic tilt angle was 49 degrees, and average RRAs (segmental angles) were RRAT12-L1 = -3.6 degrees, RRAL1-L2 = -4.1 degrees, RRAL2-L3 = -7.6 degrees, RRAL3-L4 = -11.7 degrees, RRAL4-L5 = -16.8 degrees, and RRAL5-S1 = -32.4 degrees. Using segmental rotation angles as a method to compare past and current literature, a normal standing lumbar lordosis of CobbT12-S1 = -61 degrees, range -55 degrees to -65 degrees, was determined with specific segmental angles.
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Anterior spinal fusion (ASF) has been proven to improve curve correction, save motion segments, and decrease the rate of pseudarthrosis when compared with posterior spinal fusion alone. However, in patients with idiopathic scoliosis, the complication rate of the anterior approach to the spine using current techniques has only been scantly defined in the literature. This is a retrospective review of consecutive patients who underwent primary ASF for idiopathic scoliosis to determine the prevalence and types of complications specifically related to the anterior approach. ⋯ The anterior approach to the spine in patients with idiopathic scoliosis in this series was very safe, with only one major complication in 98 patients. However, minor and insignificant complications were quite common, occurring in 45 of 98 patients (46%). Smoking was a significant risk factor for minor complications.
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A case of a large L3-L4 intervertebral disc herniation causing a widening of the intervertebral foramen is reported. There was a soft-tissue mas within the spinal canal and intervertebral foramen. ⋯ There exists a degree of overlap between the imaging of herniated discs and spinal neurinomas. When this overlap involves several aspects, such as anatomic configuration, mass enhancement, and secondary foraminal dilatation, the differential diagnosis between a herniated disc and a neurinoma may be problematic.
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Inter- and intraobserver variability in grading lumbar fusion status radiographically was assessed. The objective was to determine the interobserver variability and intraobserver reproducibility in the assessment of two level noninstrumented lumbar fusions. Fifty sets of radiographs with anteroposterior, left and right bending, and flexion-extension lateral views were assessed by six observers of varying experience and background, with fusion status graded. ⋯ Intraobserver reproducibility was higher in more experienced observers. The results indicate only fair reliability in terms of interobserver agreement to grading of lumbar fusion status. Variability in assessing lumbar fusion radiographically may explain some of the variability in fusion rates reported in the literature and poor correlation that can be seen between clinical outcome and radiologic outcome.