The spine journal : official journal of the North American Spine Society
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Review Case Reports
Brown-Sèquard syndrome produced by cervical disc herniation: report of two cases and review of the literature.
Brown-Sèquard syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has rarely been considered to be a cause of Brown-Sèquard syndrome. ⋯ Characteristic finding in discogenic Brown-Sèquard syndrome are contralateral deficit in sensation of pain and temperature of more below than a few levels below the cord compression and paracentral protruded disc with cervical spinal stenosis. Outcomes are favorable in rapid diagnosis by magnetic resonance images and performance of anterior approach.
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Comparative Study
Presurgical biopsychosocial variables predict medical and compensation costs of lumbar fusion in Utah workers' compensation patients.
Elective lumbar fusion surgery is a prevalent and costly procedure that requires a lengthy rehabilitation. It is important to identify presurgical biopsychosocial predictors of medical and compensation costs in such patients. ⋯ Compensation and medical costs associated with posterolateral lumbar fusion can be predicted by preintervention biopsychosocial variables. Cost reduction programs might benefit from identifying biopsychosocial factors related to increased costs.
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In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. ⋯ In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.
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Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus.
Prior studies have documented an increased complication rate in diabetics treated by lumbar decompression. Despite the assumption that this risk would be exacerbated in larger fusion procedures, a recent study found no such increased risk. ⋯ Patients with both IDDM and NIDDM have a significantly increased risk of perioperative complications as compared with controls when treated by lumbar instrumentation and fusion.
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Comparative Study
Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis.
Multilevel fenestration or laminectomy is generally performed to treat the patient with lumbar canal stenosis (LCS). However, in patients requiring laminectomy, little attention has been paid to the later development of lumbar pain possibly caused by a removal of the posterior elements of the spine. In general, spinal instrumentation and fusion has been generally performed when laminectomy might cause severe postoperative spinal instability. Surgical methods where osteotomized vertebral arches are repositioned rather than removed have long been performed. However, they have never become widespread, possibly because of the complicated surgical procedures and poor postoperative arch stability, which leads to a long period of postoperative immobilization. ⋯ Our surgical procedures of spinal canal enlargement using restorative laminoplasty produce complete decompression and anatomical reconstruction of the posterior elements, ligaments and muscles. Improvement in complaints of lumbago may be a consequence of the anatomical reconstruction of the posterior spinal elements. Overall, favorable results were obtained. The best results were obtained if surgery is performed within 2 years of the onset of LCS.