The spine journal : official journal of the North American Spine Society
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There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. ⋯ The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
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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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Laminoplasty aims to decompress the spinal cord and stabilize the cervical spine in patients with multilevel cervical lesions. Not every patient with cervical compressive myelopathy is a good candidate for laminoplasty. Most studies recommend that neutral or kyphotic alignments are contraindications for laminoplasty. However, cervical sagittal alignment does not have a strong and consistent effect on the clinical outcomes of laminoplasty. Moreover, many reports on the effect of cervical sagittal alignment did not designate the ideal definition of alignment and used different definitions of lordosis. ⋯ Despite nonlordosis cervical sagittal alignment, double-door laminoplasty would be effective for patients with cervical myelopathy because of cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. Furthermore, sagittal alignment is not the absolute and sole factor that surgeons should consider when determining the optimal treatment strategy.
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Tuberculosis (TB) of the cervical spine occurs rarely in younger children whereas the presentation and outcome are different from those of adult cervical spine. Because cervical spinal TB in younger children is rarely reported, the clinical characteristics, the treatments, and the expected outcome of treatments in younger children are still unknown. ⋯ Based on our experiences in this case and a review of the literature, we propose that for patients of cervical spine TB in early childhood, anterior excision of diseased bone without grafting should be adequate as a surgical measure.
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Characteristic changes of the facet joints, including synovial cysts, facet joint hypertrophy, and facet joint effusions, on magnetic resonance imaging (MRI) and computed tomography have been associated with lumbar degenerative spondylolisthesis. The cervical facets have not been examined for associations with cervical degenerative spondylolisthesis similar to those seen in the lumbar spine. ⋯ Supine MRIs underestimate sagittal displacement compared with upright lateral radiographs. Asymmetric facet hypertrophy at C3-C4 and C4-C5 is associated with degenerative spondylolisthesis on upright lateral films even in the absence of anterolisthesis on supine MRIs.