The spine journal : official journal of the North American Spine Society
-
There are few reported cases of failed axial lumbar interbody fusion (AxiaLIF) in the existing neurosurgical literature, and an anecdotal case of open paramedian retroperitoneal approach to L5-S1 level for retrieval of AxiaLIF rod has been published. ⋯ To the authors' knowledge, this is the first report demonstrating the safety and efficacy of minimally invasive presacral approach for removal of AxiaLIF rods in patients with failed AxiaLIF. As the AxiaLIF procedure is rapidly gaining acceptance among spine surgeons, we can expect to see increasing numbers of failed procedures as well. Understanding options for revision strategies is important for surgeons considering the use of this technique.
-
Readmissions within 30 days of hospital discharge are undesirable and costly. Little is known about reasons for and predictors of readmissions after elective spine surgery to help plan preventative strategies. ⋯ Among Medicare beneficiaries, 30-day readmissions after elective spine surgery for degenerative conditions represent a target for improvement. Both patient factors and operative techniques are associated with readmissions. Interventions to minimize readmissions should be specific to surgical site and focus on high-risk subgroups where clinical trials of interventions may be of greatest benefit.
-
Several reports suggest that level- and side-specific multifidus atrophy or fat infiltration may be related to localized spinal pathology and symptoms. In particular, a study using a porcine model reported rapid level- and side-specific multifidus atrophy and adipocyte enlargement resulting from anterolateral disc or nerve root lesions. ⋯ Multifidus may be particularly responsive to, or indicative of, localized lumbar disc or nerve root pathology within the first 6 weeks of symptoms as expressed through fat infiltration, but not through CSA asymmetry on MRI. However, such measurements are not reliable markers of lumbar pathology on an individual basis for use in clinical or research settings.
-
Driving is a functional complaint of many individuals with chronic whiplash-associated disorders (WAD). Current driving scales do not include the most troublesome driving tasks for this group, which suggests that a new tool is required to assess perceived driving difficulty in this population. ⋯ The NPDI was developed to assess the degree of perceived driving difficulty in the chronic whiplash population. Reliability and validity of the NPDI were ensured. The NPDI can be the entry point for discussions on driving difficulties between clinicians and patients with chronic WAD.