The spine journal : official journal of the North American Spine Society
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Detection of ossification of the posterior longitudinal ligament (OPLL) of lesions by lateral radiography is sometimes difficult because the lesions are small. Three-dimensional computed tomography (3D CT) imaging has made it possible to detect lesions not been seen by lateral radiography. ⋯ Three-dimensional computed tomography visualization of OPLL provided the basis of a classification system, superior to lateral radiography, and provided new information about OPLL. Combining 3D CT with MRI might be useful to provide details about spinal cord compression in OPLL.
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In obese patients, placing pedicle screws percutaneously is a particular challenge. As the bulky and thick configuration of obese patients may produce fuzzier fluoroscopic view and longer passage of surgical instruments, the chances of misplacement might increase. ⋯ Although symptomatic pedicle violations were noted in the earlier period of surgeon's learning curve and in overweight and obese patients, no statistical evidence could be found between patient's body habitus and percutaneous pedicle screw misplacement. Our data also suggest that greater caution should be exercised to avoid pedicle violations especially at L3 and L4.
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Few studies have analyzed the results of an interspinous distraction device in patients with lumbar spinal stenosis. It is still unknown whether the outcomes of an interspinous implant are related to the severity of stenosis. ⋯ The Aperius interspinous implant is poorly indicated for severe lumbar stenosis, which is significantly improved only in a small minority of cases, whereas decompression procedures ensure high chances of good results. The implant may be indicated for selected patients with moderate stenosis. The outcomes of the Aperius are not influenced by the type of clinical presentation of lumbar stenosis.
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Research on lumbosacral transitional vertebra (LSTV) has yielded important information on the structural alterations of the sacrum associated with LSTV. Nevertheless, very little data are available on the relationship of a given type of LSTV with either a typical pattern of sacral morphology or its gender distribution in the population. ⋯ Different lumbosacral transitions share a stronger, definite, and specific patterns of relationship with certain sacral morphologies and gender. It is important to recognize the nuances of these connections so as to understand low back pain conditions in the setting of a typical sacral articular morphology or the sex of the individual.