The spine journal : official journal of the North American Spine Society
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Comparative Study
The impact of generalized joint laxity on the occurrence and disease course of primary lumbar disc herniation.
Generalized joint laxity (GJL) has been associated with spine-related disorders such as low back pain, accelerated disc degeneration, and recurrence after discectomy surgery for primary lumbar disc herniation (p-LDH). Generalized joint laxity might be a causative factor of p-LDH, but this relationship is poorly understood. In addition, the impact of GJL on outcomes after the treatment for p-LDH has not been reported. ⋯ Generalized joint laxity was closely related to p-LDH and may be a causative factor. In addition, patients with GJL had worse clinical and radiological outcomes than patients without GJL. Consequently, GJL should be evaluated preoperatively, and this information should be communicated to p-LDH patients with GJL.
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Surgical treatment of thoracolumbar tuberculosis (TB) aims at spinal cord decompression, focus debridement, spine stability, and deformity correction. However, several problems exist in treating multiple segmental thoracolumbar TB, including reducing surgical trauma with effective incision exposure; ensuring the effective long-armed fixation, and maintaining the possibility for revisionary surgery in cases of treatment failure. ⋯ Combined with anti-TB chemotherapy, the discussed surgical technique can show improved lesion clearance, decompression of the anterior aspect of the spine, bone graft fusion, internal fixation of outside lesions, drainage and lead to positive treatment outcomes.
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Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing. ⋯ Global coronal malalignment is more prevalent in patients with PD than in controls. Greater severity of PD was significantly associated with greater magnitude of scoliosis Cobb angle, even after adjusting for the effects of patient age and gender. However, direction of scoliosis and side of global coronal malalignment were not significantly associated with the dominant laterality of PD symptoms.
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Observational Study
Indirect effects of decompression surgery on glycemic homeostasis in patients with type 2 diabetes mellitus and lumbar spinal stenosis.
Lumbar spinal stenosis (LSS) patients with diabetes mellitus (DM) are presumed to experience difficulty when performing regular daily exercise, although such exercise is of paramount importance for glucose homeostasis and control. Therefore, decompression surgery, which can help patients perform regular physical activity, would have indirect positive effects on blood glucose control in LSS patients with DM. ⋯ The present study demonstrates the reduction in HbA(1c) level in patients with DM and LSS after decompression surgery with or without fusion. We believe this reduction in the HbA(1c) level may be a result of increased physical activity, subsequent to successful surgical decompression of the cauda equina.
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The Surgical Apgar Score (SAS), a simple metric based on intraoperative heart rate, blood pressure, and blood loss, was developed in general and vascular surgery to predict 30-day major postoperative complications and mortality. No validation of SAS has been performed in spine surgery. ⋯ Surgical Apgar Score allows risk stratification and has a good discriminatory power in patients undergoing spine surgery.