The spine journal : official journal of the North American Spine Society
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Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis.
Lumbar spinal stenosis is now the most common and fastest growing reason for spinal surgery in adults older than 65 years. There are not yet clearly identified preoperative predictive factors for postoperative clinical outcome. We have previously reported on the clinical outcome of patients treated operatively and nonoperatively. ⋯ On average, patients who choose to have surgery will have improvement. However, not all patients having surgery will note improvement, and there are factors predictive for outcome.
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Hemangiopericytoma (HPC) occurs infrequently in the central nervous system. Spinal involvement is particularly uncommon; and intradural localization is rare. Here, we describe an intradural extramedullary thoracic HPC that went undiagnosed initially on computed tomography scan of the abdomen. ⋯ The standard treatment for HPC is surgery when the lesion is resectable. Despite gross total resection, there is still a high risk of recurrence and metastasis; therefore, patients should be followed up closely by their physicians with serial postoperative clinical examinations and radiographic imaging.
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Several fusion techniques are used to treat atlantoaxial instability. Recent literature suggests that intralaminar screw (LS) fixation and pedicle screw (PS) fixation offer similar stability and comparable pullout strength. No studies have compared these characteristics after cyclic loading. ⋯ Our data suggest that a C1LM and C2LS construct has similar biomechanical stability when compared with a C1LM and C2PS construct after 1,000 cycles of axial rotation. Furthermore, PSs had higher pullout strength when compared with LSs; however, this result was not statistically significant.
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Treatment guidelines suggest that most acute low back pain (LBP) episodes substantially improve within a few weeks and that immediate use of imaging and aggressive therapies should be avoided. ⋯ Contrary to clinical guidelines, many patients with LBP start incurring significant resource use and associated expenses soon after the index diagnosis. Achieving guideline-concordant care will require substantial changes in LBP practice patterns.