The spine journal : official journal of the North American Spine Society
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Lumbar metastases can result in spinal instability and mechanical radiculopathy, characterized by radicular pain produced by axial loading. This pain pattern represents a definitive symptom of neoplastic instability and may serve as a reliable indication for surgical stabilization. ⋯ Mechanical radiculopathy in patients with spinal metastases represents a highly reliable surgical indication. Spinal decompression and fixation is an effective treatment for pain palliation in this patient population.
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Epidural steroid injections (ESIs) have been used for a number of years in the treatment of radicular pain caused by nerve root impingement or stenosis after failed conservative treatments with oral medications, physical therapy, and lifestyle modifications. ⋯ Predictive tools for ESI outcomes, such as nerve root compression grading and inflammatory markers, particularly, elevated IFN-γ from epidural lavage fluid, seem promising in the future. At this time, future research is needed with a larger sample size, broader spectrum of patients, and a more defined system of outcome measurements at standardized follow-up periods before practice recommendations can be made.
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Comparative Study Observational Study
Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study.
In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce. ⋯ Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery.
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Magnetically-controlled growing rod (MCGR) technology has been reported for the treatment of early-onset scoliosis (EOS). Such technology allows for regular and frequent outpatient rod distractions without the need for additional surgery. However, pre- and postdistraction spine radiographs are required to verify the amount of lengthening. This increased exposure to ionizing radiation in developing children significantly increases their risk profile for radiation-induced cancer and noncancerous morbidity. ⋯ This is the first study to report the use of a novel technique using noninvasive, nonionizing ultrasound to reliably document rod distractions in EOS patients. A high level of inter- and intrarater reliabilities were noted. More importantly, the use of ultrasonography may result in fewer whole spine radiographs from being taken in patients who have had MCGRs implanted for EOS; thereby decreasing their exposure to ionizing radiation and the potential risk of future radiation-induced diseases.
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Comparative Study
Preoperative computer-based simulations for the correction of kyphotic deformities in ankylosing spondylitis patients.
A preoperative plan is important to obtain appropriate balance of the sagittal plane in patients with kyphotic deformity. Previous methods to calculate the correction angle are inconvenient and complicated, whereas the method using computer simulations may be very effective and much simpler than existing methods. ⋯ Comparisons of preoperative simulations and actual surgical outcomes showed significant coincidences; thus, evaluations through computer simulations before surgery are expected to help predict the level of correction possible after surgery and improve surgical planning.