The spine journal : official journal of the North American Spine Society
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Although routine transection of the C2 nerve root during atlantoaxial segmental screw fixation has been recommended by some surgeons, it remains controversial and to our knowledge no comparative studies have been performed to determine whether transection or preservation of the C2 nerve root affects patient-derived sensory outcomes. ⋯ C2 nerve root transection is not a benign procedure and, in our experience, more than a quarter of the patients experience increased neuralgic pain following C2 nerve root transection. Because the prevalence and intensity of postoperative neuralgia was significantly higher with C2 nerve root transection than with its preservation, we recommend against routine C2 nerve root transection when performing atlantoaxial segmental screw fixation.
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Few studies exist for magnetic resonance imaging (MRI) issues and ballistics, and there are no studies addressing movement, heating, and artifacts associated with ballistics at 3-tesla (T). Movement because of magnetic field interactions and radiofrequency (RF)-induced heating of retained bullets may injure nearby critical structures. Artifacts may also interfere with the diagnostic use of MRI. ⋯ Ballistics made of lead with copper or alloy jackets appear to be safe with respect to MRI-related movement at 1.5-, 3-, and 7-T static magnetic fields, whereas ballistics containing steel may pose a danger if near critical body structures because of strong magnetic field interactions. Temperature increases of selected ballistics during 3-T MRI was not clinically significant, even for the ferromagnetic projectiles. Finally, ballistics containing steel generated larger artifacts when compared with ballistics made of lead with copper and alloy jackets and may impair the diagnostic use of MRI.
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Review Practice Guideline
An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update).
The evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spinal stenosis by the North American Spine Society (NASS) provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spinal stenosis. The guideline is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spinal stenosis as reflected in the highest quality clinical literature available on this subject as of July 2010. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder. ⋯ A clinical guideline for degenerative lumbar spinal stenosis has been updated using the techniques of evidence-based medicine and using the best available clinical evidence to aid both practitioners and patients involved with the care of this condition. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, will be available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.