The spine journal : official journal of the North American Spine Society
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Intraoperative somatosensory evoked potential (SSEP) monitoring has been shown to reduce the incidence of new postoperative neurological deficits in scoliosis surgery. However, its usefulness during cervical spine surgery remains a subject of debate. ⋯ ACDF appears to be a safe surgical procedure with a low incidence of iatrogenic neurological injury. Transient SSEP signal changes, which improved with intraoperative interventions, were not associated with new postoperative neurological deficits. An intraoperative neurological deficit is possible despite normal SSEP signals.
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One traditional treatment for spondylolisthesis is fusion. However, for high-grade spondylolisthesis and spondyloptosis, posterior fusion has had high rates of nonunion, progression, and persistent physical deformity. Thus, some surgeons have recommended reduction and instrumentation. One such technique (Gaines procedure) entails a two-stage procedure: L5 vertebrectomy anteriorly, followed by resection of the L5 posterior elements and instrumented reduction of L4 onto S1. However, to our knowledge, there is no report of reversing the fusion and deformity reduction in a symptomatic patient with previous solid fusion of the spondyloptosis at L5-S1. ⋯ The Gaines procedure has been performed successfully in patients without previous fusions at the level of spondylolisthesis or spondyloptosis. Patients for whom the traditional posterior fusion fails still may be candidates for this procedure, albeit at increased risk of neurologic injury.
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Discography has been successfully used to distinguish painful from asymptomatic intervertebral discs. ⋯ In cases of interbody lumbar fusion with questionable solidity, marcain injection within the disc space can help in the assessment of the source of pain even at the intervertebral spaces with cages.
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Lumbar discography has been widely used to evaluate discogenic low back pain. Anecdotal evidence suggests that pain reproduction during discography is more closely correlated with peak dynamic pressure than with static postinjection pressure. Although there can be a significant difference between dynamic and static pressures, to date most discographic evaluations use static pressure recorded postinjection (which is stable and easily measured). The use of readings taken after injection, rather than readings of maximum dynamic peak pressure recorded during injection, appear to increase false positives in lumbar discography. High-speed intradiscal injections also appear to have potentially confounding effects that may increase the rate of false-positive responses during lumbar discography. To date there has been no study for the evaluation of peak dynamic intradiscal pressures or for differentiating dynamic from static pressures in the nucleus pulposus (NP) in response to various speeds of intradiscal injection. ⋯ Dynamic and static intradiscal pressures are of similar value when measured by manometer and by needle sensor at slow injection speeds during discography. However, the pressure differences appeared to rapidly increase in response to incremental increases in injection speed. The data from these 82 samples suggest that uncontrolled high speeds of intradiscal injections are a potential confounding factor, which may increase false-positive responses during lumbar discography.