The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial Comparative Study
Lumbar microdiscectomy under epidural anesthesia: a comparison study.
Lumbar microdiscectomy is most commonly performed under general anesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under epidural anesthesia. ⋯ Epidural anesthesia as an alternative to general anesthesia has shown less postoperative nausea and vomiting in lumbar microdiscectomy. Nevertheless, given the small number of patients, this study should be considered as preliminary, showing small differences in minor potential complications.
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Multicenter Study
Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma.
Posterior ligamentous complex (PLC), consisting of supraspinous ligament (SSL), interspinous ligament (ISL), ligamentum flavum (LF), and the facet joint capsules is thought to contribute significantly to the stability of thoracolumbar spine. Currently, no consensus exists on radiographic imaging parameters that may indicate injury to the posterior ligamentous complex. ⋯ Plain radiographic findings were felt to be most helpful in determining PLC injury by the members of the Spine Trauma Study Group. Physical examination findings and history of the mechanism of injury were ranked lower than imaging studies. Future analysis should focus on indicators of PLC injury when plain radiographic findings are either subtle or not present.
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Randomized Controlled Trial
Validity of the new Backache Index (BAI) in patients with low back pain.
The Backache Index (BAI) is applied to patients with low back pain (LBP) in order to help therapists, doctors, and surgeons perform physical examinations easily. It is carried out within a short space of time (<2 min) without using inclinometric instruments. ⋯ The BAI appears to be a reliable and valid assessment of overall restricted spinal movements in case of LBP and discriminates between successful and unsuccessful treatment outcome.
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Comparative Study Clinical Trial
Balloon kyphoplasty for vertebral compression fractures in solid organ transplant recipients: results of treatment and comparison with primary osteoporotic vertebral compression fractures.
Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs. ⋯ These data suggest that balloon kyphoplasty can be performed safely in organ transplant recipients with VCFs. The degree of pain relief is equivalent to that seen in patients with primary osteoporosis. Results are durable at 12-month follow-up. Transplant patients developed earlier and more severe bony disease, with more severe baseline pain, a higher incidence of multiple fractures at the time of diagnosis, and a greater risk of new fracture development posttreatment, as compared with the primary osteoporosis group.
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Unstable lesions of the cervicothoracic junction present a severe clinical problem for diagnosis, treatment, and prognosis. ⋯ The surgical procedure was chosen according to the particularity of the anatomical region and the possibility of associated medullar decompression. Insertion of pedicle screws in the upper thoracic portion in T1, T2, and T3 requires a careful technique and knowledge of the posterior projection points of the pedicles and their orientation in space. The high rate of fusion observed in these patients justified posterior reduction and stabilization. The high death rate and the low rate of neurological recovery in this group of patients emphasizes the severe prognosis of unstable injuries of the cervicothoracic junction. Considering the few mechanical failures observed at the last examination, the choice of the posterior approach was appropriate as the one stage procedure. Plate synthesis is preferable in fractures that do not require extension of synthesis beyond T2, whereas screws and rods systems are more appropriate for superior thoracic injuries. Despite early diagnosis and surgical treatment, the presence of neurological or pulmonary lesions resulted in increased mortality of the operated patients.