Global spine journal
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Global spine journal · Aug 2014
Case ReportsTraumatic Dissection of Four Brain-Supplying Arteries without Neurologic Deficit.
Study Design Case report and review of the literature. Objectives Case report of a traumatic dissection of all major brain-supplying arteries resulting from a horseback-riding accident. Overview of the literature on diagnostic and therapeutic recommendations. ⋯ Conclusion In case of high-energy trauma of the head and/or the neck, emergency physicians must consider traumatic cervical artery dissection (TCAD). Thus, emergency care algorithms should routinely include computed tomography angiography and magnetic resonance imaging. Although the incidence of TCAD-induced stroke is low, antiplatelet therapy is recommended in the presence of TCAD.
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Global spine journal · Jun 2014
The Incidence of Adjacent Segment Breakdown in Polysegmental Thoracolumbar Fusions of Three or More Levels with Minimum 5-Year Follow-up.
Study Design Retrospective cohort study. Objective To identify the incidence of adjacent segment pathology (ASP) after thoracolumbar fusion of three or more levels, the risk factors for the development of ASP, and the need for further surgical intervention in this particular patient population. Methods A retrospective analysis of a prospective surgical database identified 217 patients receiving polysegmental (≥ 3 levels) spinal fusion with minimum 5-year follow-up. ⋯ Age, preoperative degenerative diagnosis, and absence of fusion demonstrated significant association to ASP. Conclusions ASP was observed in a significant number of patients receiving polysegmental fusion of three or more levels. ODI scores correlated to RASP, CASP, and the need for revision surgery.
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Global spine journal · Jun 2014
Preoperative predictors of patient satisfaction with outcome after cervical laminoplasty.
Study design Prospective cohort study. Objective The purpose of the present study was to identify the predictors of patient satisfaction with outcome after cervical laminoplasty for compressive cervical myelopathy. Methods A cohort of 143 patients with compressive myelopathy who underwent cervical double-door laminoplasty between 2008 and 2011 was studied prospectively. ⋯ The unsatisfied group ("neutral" or less) showed significantly lower baseline SF-36 scores in bodily pain (BP), general health perceptions (GH), and vitality (VT) domains compared with the satisfied group. At the 1-year follow-up, SF-36 scores showed significant differences between the groups in all eight domains, whereas the JOA score showed no significant difference. Conclusions Lower baseline QOL measured by SF-36 scores, specifically in BP, GH, and VT domains, are associated with lower satisfaction with outcome after cervical laminoplasty.
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Global spine journal · Feb 2014
Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.
Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. ⋯ There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental health status outcomes.
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Global spine journal · Feb 2014
Fluoroscopically guided extraforaminal cervical nerve root blocks: analysis of epidural flow of the injectate with respect to needle tip position.
Study Design Retrospective evaluation of consecutively performed fluoroscopically guided cervical nerve root blocks. Objective To describe the incidence of injectate central epidural flow with respect to needle tip position during fluoroscopically guided extraforaminal cervical nerve root blocks (ECNRBs). Methods Between February 19, 2003 and June 11, 2003, 132 consecutive fluoroscopically guided ECNRBs performed with contrast media in the final injected material (injectate) were reviewed on 95 patients with average of 1.3 injections per patient. ⋯ Conclusion To ensure central epidural flow with ECNRBs one must be prepared to pass the needle tip medial to midplane of the lateral mass or to medial cortex of the lateral mass. Approximately 16% of ECNRBs with needle tip medial to midline of the lateral mass did not flow into epidural space. One cannot claim a nerve block is an epidural block unless epidural flow of injectate is observed.