The spine journal : official journal of the North American Spine Society
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Information about complications and mortality after surgery for correction of idiopathic scoliosis has been largely derived from single-institution series. Regional or national studies have been lacking. ⋯ We have provided a national perspective on inpatient complications, mortality, and discharge disposition after spinal fusion for idiopathic scoliosis in the United States. The significant negative effects of postoperative complications on mortality and resource utilization have been demonstrated. Furthermore, we have identified adult age, male gender, and preoperative comorbidity as important risk factors and defined their impact on patient outcomes.
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The impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method. ⋯ The minimum detectable change (MDC) appears as a statistically and clinically appropriate MCID value. MCID values in this sample were 12.8 points for ODI, 4.9 points for PCS, 1.2 points for back pain, and 1.6 points for leg pain.
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Elucidation of the factors responsible for symptomatic failure of spinal instrumentation has been a keen interest for many investigators. ⋯ Failure to correct sagittal plane deformity intraoperatively predisposes patients to SIF regardless of age, level of surgery, or indication of surgery.
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Case Reports
Catastrophic intramedullary hematoma following Kümmell's disease with large intravertebral cleft.
Kümmell's disease is defined as avascular osteonecrosis and occurs after delayed posttraumatic vertebral collapse. Devastating cord injury with Kümmell's disease is rare except in advanced cases with kyphosis and posterior cortex breakage. ⋯ An increasing awareness of the delayed vertebral collapse with cord injury attached to an osteoporotic spine fracture, as well as a periodic follow-up and treatment are essential for preventing catastrophic neurological impairment.
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Seven previous systematic reviews (SRs) have evaluated back schools, and one has evaluated brief education, with the latest SR including studies until November 2004. The effectiveness of fear-avoidance training has not been assessed. ⋯ Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting. The discordance between reviews can be attributed differences in inclusion criteria and application of evidence rules.