The spine journal : official journal of the North American Spine Society
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The minimal clinically important difference (MCID) is defined as the smallest change in an outcome that a patient would perceive as meaningful. The Initiative on Methods, Measurement and Assessment in Clinical Trials (IMMPACT) group proposed defining the MCID as a 30% improvement in self-reported pain or function. However, this MCID threshold has not been validated against an objective physical measure. ⋯ Despite extensive use of the MCID to evaluate effects of treatment in spinal disorders, this is the first empirical documentation of the validity of the IMMPACT's 30% change criterion compared with an objective physical anchor.
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Posterior spine fusion is associated with significant intra- and postoperative blood losses. When referring to the total blood loss during spine surgery, the standard is to measure the intraoperative bleeding plus the postoperative drainage. This ignores the "hidden" blood loss that was found to be significant in other fields of surgery. ⋯ After posterior spinal fusion, there may be a large amount of the hidden blood loss.
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Pedicle screws have shown to be a safe and effective method of spinal fixation, offering superior multiplanar correction compared with hooks or sublaminar wires in selected situations. Though only food and drug administration (FDA) approved in the adolescent population, they are commonly used in an off-label manner in the preadolescent population. ⋯ The complication rates in the young pediatric population associated with the off-label use of pedicle screws for spinal fusions are not statistically different from the complication rates associated with the FDA-approved adolescent population.
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Although complete resection is the preferred surgical treatment for ossification of the ligamentum flavum (OLF), it sometimes results in the floating method because of adhesion to, or ossification of, the dura mater. It is difficult to anticipate the degree of floating, and if the floated ossification is large, decompression of the spinal cord may not be sufficient. ⋯ Our present study is the first report that showed OLF was reduced after the floating method. Reduction of the floated ossification was observed 5 weeks after the operation.