Journal of spinal disorders
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Multicenter Study Comparative Study
Day surgery for cervical microdiscectomy: is it safe and effective?
The objective of this pilot study was to evaluate the safety and efficacy of cervical discectomy with fusion performed on an outpatient basis. The experimental group (50 consecutive patients) was studied prospectively and the outcomes were compared with 53 consecutive, retrospectively analyzed, admitted controls who underwent the same procedure. Outcomes for both groups were assessed by patient-response questionnaires and clinical examination. ⋯ There was no mortality and the operative complication rate was 2% for each study group. The results indicate that conversion of cervical discectomy with fusion from an admitted to an ambulatory practice did not compromise the safety or efficacy of the surgical procedure. Potential economic savings to overall health costs of the United States that might result from such conversion could exceed $100 million annually.
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An anatomical study of the passage of the implant placed around thoracic transverse process was undertaken in human cadavers to investigate the safety of thoracic transverse process fixation. A simulated surgical procedure for implant placement around the transverse processes of T1-T10 was carried out in eight fresh human cadavers using a mock plastic implant, 7.0 mm wide and 1.5 mm thick. A total of 80 implanted thoracic vertebrae were dissected systematically. ⋯ The parietal pleura, the intercostal vessels, and intercostal nerves were not injured by the implants in any of the specimens. All the implants were located posterior to the intercostal nerves and vessels, lateral to the pedicles, and outside the spinal canal. The transverse processes of T1-T10 are safe structures for implant anchorage in posterior spinal instrumentation.
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The association between subjective experience in pain reduction and objective measurements in improvement of physical functioning was analyzed with chronic low back pain (CLBP) patients (n = 143) who attended a 12-week multidimensional back treatment program emphasizing active functional restoration. Low back flexion-extension, lateral flexion and rotation, isometric strength, and mobility and their changes were measured. The results showed that 79% of the subjects reported subjective decrease in LBP during the 12-week restoration program, and simultaneous increases in isometric strength and mobility also were measured in approximately 80% of the subjects. ⋯ Thus, absolute levels at the baseline or magnitude of changes in the measurements of maximum isometric strength or mobility were not associated with pain reduction. The results indicate that subjective pain reduction is significantly associated with improvement per se in trunk muscle function and spinal mobility during active functional restoration, but not with the magnitude of the improvements. This should be considered when designing rehabilitation programs and outcome criteria for rehabilitation.
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Combined anterior and posterior fusion with posterior instrumentation may be indicated in the treatment of select cases of L5-S1 spondylolisthesis. The instrumentation, however, is expensive and usually bulky, occasionally requiring removal. In an effort to avoid these problems, an L5-S1 paralaminar screw technique was developed for posterior stabilization after an L5-S1 anterior interbody fusion. ⋯ Compared with other posterior instrumentation systems, this screw fixation is inexpensive and does not require implant removal. The disadvantages of the method are the degree of difficulty of the procedure and the limited clinical application to cases of L5-S1 spondylolisthesis with corrected residual slips of 25 to 50-60%. The procedure is technically demanding and should be limited to those surgeons who are comfortable with the method.
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Twenty-five consecutive patients who had previously undergone lumbar fusion using stainless steel pedicle screw instrumentation and complained of persistent, severe pain were identified for prospective study. All patients had been scheduled for hardware removal and fusion inspection. Studies to rule out pseudarthrosis included plain radiography, flexion and extension radiography, computed tomography, and bone scintigraphy. ⋯ Each patient then underwent surgery, at which time the pedicle screw instrumentation was removed and the fusion was inspected. Using surgical inspection as absolute evidence of fusion or pseudarthrosis, statistical analysis was undertaken to evaluate the predictive value of the radiographic studies singly and in combination. No statistically significant correlation was found.