The spine journal : official journal of the North American Spine Society
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Vertebral artery injuries (VAIs) are rare but serious complications of cervical spine surgery, with the potential to cause catastrophic bleeding, permanent neurologic impairment, and even death. The present literature regarding incidence of this complication largely comprises a single surgeon or small multicenter case series. ⋯ The overall incidence of VAI during cervical spine surgery reported from this survey was 0.07%. Less experienced surgeons had a higher rate of VAI compared with their more experienced peers. The results of VAI are highly variable, resulting in no permanent harm most of the time; however, permanent neurologic injury or death occur in 10% of cases.
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Randomized Controlled Trial
Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study.
A period of nonsurgical management is advocated before surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal nonsurgical management. Physical therapy is often used, however its use and effectiveness relative to other nonsurgical strategies has not been adequately explored. ⋯ Many patients with lumbar spinal stenosis pursuing conservative management receive physical therapy. Using physical therapy was associated with reduced likelihood of patients receiving surgery within 1 year. Results for other outcomes were mixed with no differences in several measures. Further research is needed to examine the effectiveness of physical therapy relative to other nonsurgical management strategies for patients with lumbar spinal stenosis.
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Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. ⋯ Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.
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Comparative Study
A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion.
Emerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes. ⋯ MIS TLIF technique demonstrated significant reductions of operative time, LOS, anesthesia time, VAS scores, and EBL compared with the open technique. This reduction in perioperative parameters translated into lower total hospital costs over a 60-day perioperative period. Although hospital reimbursements appear higher in the open group over the MIS group, shorter surgical times and LOS days in the MIS technique provide opportunities for hospitals to reduce utilization of resources and to increase surgical case volume.