The spine journal : official journal of the North American Spine Society
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The existing evidence suggests that, although older spinal cord injury (SCI) patients experience a similar degree of neurologic recovery to younger patients, older patients experience diminished functional outcomes at follow-up. However, all studies have assumed that the impact of age on functional outcome is the same across the spectrum of injury severity. ⋯ Overall, advanced age is associated with worse functional outcome after SCI; however, this effect varies across the spectrum of injury severity. These results will help to facilitate enhanced clinical communication as well as potentially aid in the development of customized treatment and rehabilitation protocols.
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Nonorganic low back pain (NOLBP) is common in the worker's compensation (WC) population. Consults with specialists constitute an unnecessary cost to the system, and a means of screening for these patients is necessary. ⋯ We found a significant association between certain easily identifiable criteria and NOLBP in a cohort of WC patients. These criteria included mechanism of injury including slip and fall or lifting of a patient, alleged injury in greater than two bodily areas, presence of concomitant cervical and/or thoracic complaints, initial presentation to chiropractor, and areas of pain different from first report of injury. More than 95% of patients with three or more of the aforementioned criteria were found to have nonorganic pain. This information may help the specialist and the WC provider identify patients at a high risk for nonorganic pain, thereby reducing unnecessary costs.
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Among the various forms of laminoplasty fixation, plate augmentation provides a semirigid arch reconstruction and is gaining popularity as the result of its safety and effectiveness. However, the effects of this procedure on hinge status and subsequent bony healing remain unclear. ⋯ Although plate-only, open-door laminoplasty is a safe and reliable surgery for decompression of multilevel cervical disease, the fixation that it provides on the open side may not be sufficiently stable to allow successful primary healing. Additional attention should be paid to the hinged side to prevent delayed fracture in the early postoperative period and to reduce postoperative axial pain.
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Postoperative malalignment of the cervical spine may alter cervical spine mechanics and put patients at risk for clinical adjacent segment pathology requiring surgery. ⋯ Our results suggest that malalignment of the cervical spine following an ACF at C5-C6 has an effect on the development of clinical adjacent segment pathology requiring surgery.
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Several methods for C1-C2 stabilization have been described in the literature. These include C1-C2 transarticular and C1 lateral mass screws. In patients with aberrant anatomy such as a high-riding vertebral artery (VA) or the presence of an arcuate foramen at C1, there exists a higher risk of VA injury. This may lead to excessive bleeding, stroke, and possibly death. There have been several studies determining the incidence of arcuate foramen and high-riding VA occurring individually in the general population, but none have determined their occurrence simultaneously. ⋯ The arcuate foramen and high-riding VA are common anomalies that are often not recognized. Although ipsilateral high-riding VA and arcuate foramen rarely occur in the general population, proper identification of these anomalies on preoperative CT scan facilitates planning the safest technique for C1-C2 instrumentation.