The spine journal : official journal of the North American Spine Society
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Clinical Trial
Vacuum-assisted wound closure of deep infections after instrumented spinal fusion in six children with neuromuscular scoliosis.
The rate of infection after spinal fusion in neuromuscular scoliosis is reported to range from 4% to 20%. Infection persists in about 50% after traditional treatment including debridement and closure. Instrumentation removal is necessary in up to 28%. ⋯ The VAC system, in combination with antibiotic therapy, seems to be a useful method for treatment of deep wound infections after spinal fusion in pediatric neuromuscular scoliosis. It may prevent removal of the instrumentation and multiple surgery for irrigation and closure of the wound.
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The surgical decompression of a symptomatic lumbar nerve root is generally regarded as effective treatment for radiculopathy. Nevertheless this straightforward surgical procedure is not universally successful, and the results are often independent of technical factors. ⋯ Although psychosocial issues (psychiatric factor, personal injury litigation, compensation claim) are well known to affect outcome, the strength and magnitude of their negative effects was surprising. The short form McGill Pain Questionnaire can be used not only as an outcome tool, but also as a predictor of result. The pain drawing has similar utility, but it should not be used as a substitute for psychiatric evaluation. The numerous issues exerting profound effects on the outcome of a relatively simple operation suggest that specific attention be directed at them when evaluating more complex surgical procedures. Although large randomized samples might obviate this concern, it is possible that some of these factors are too powerful to be ignored.
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Comparative Study
Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty.
Osteoporotic vertebral compression fractures (VCFs) are being increasingly treated with minimally invasive bone augmentation techniques such as kyphoplasty and vertebroplasty. Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent VCFs after such procedures. ⋯ Vertebroplasty appears to offer a comparable rate of postoperative pain relief as kyphoplasty while using less bone cement more often via a unilateral approach and without the attendant risk of adjacent level fracture.
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Comparative Study
An economic model of one-level lumbar arthroplasty versus fusion.
Degenerative disc disease (DDD) is a cause of low back pain commonly requiring surgical intervention. The option of lumbar total disc replacement (TDR) represents an advance in the surgical treatment of DDD. However, new treatments, particularly those that include the use of new implants, may lead to increased costs to both hospitals and payers. Therefore, it is both necessary and appropriate to examine the potential costs associated with a new procedure such as total disc replacement compared with traditional treatments for a specific pathology. ⋯ The model shows that the overall economic effect of one-level TDR procedures on hospitals and payers is likely to be less than or at worse equivalent to one-level lumbar fusion procedures.
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Diastematomyelia is a split-cord malformation often accompanied by other cord or column anomalies. ⋯ Initial presentation of diastematomyelia is rarely seen in adults; accompanying pathology includes scoliosis, tethered cord, and intradural tumors. Effective treatment involves identification of the primary pathology.