The spine journal : official journal of the North American Spine Society
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Lumbar laminectomy and discectomy surgeries are among the most common procedures performed in the United States, and often take place at academic teaching hospitals, involving the care of resident physicians. While academic institutions are critical for the maturation of the next generation of attending surgeons, concerns have been raised regarding the quality of resident-involved care. There is conflicting evidence regarding the effects of resident participation in teaching hospitals on spine surgery patient outcomes. As the volume of lumbar laminectomy and discectomy increases, it is imperative to determine how academic status impacts clinical and economic outcomes. ⋯ Elective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days postoperatively compared to nonteaching hospitals. Teaching hospitals had a decreased risk of return to the operating room at 30 days, 90 days and 1 year postoperatively. Our findings might serve as an impetus for other states or regions to compare outcomes at teaching and nonteaching sites.
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Ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF) are not uncommon independent causes of thoracic myelopathy (TM); however, concomitant OPLL and OLF at the same segment is rare. The ideal surgical strategy remains controversial, and it is difficult for surgeons to balance sufficient neural decompression while simultaneously reducing the occurrence of postoperative neurological defect after circumferential decompression (CD). Aiming to solve this dilemma, we investigated a CD-based surgery using intraoperative ultrasound (IOU) assistance to evaluate spinal decompression sufficiency. ⋯ One-stage CD-based surgery via a posterior approach with IOU assistance for the treatment of concomitant OPLL and OLF led to significant functional improvement in the majority of patients. Under the premise of sufficient decompression, the postoperative paralysis rate reduced compared to that in previous studies. However, there were still high cerebral spinal fluid leakage rates. Considerable blood loss is a risk factor for poor RR.
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In a very brief period, the COVID-19 pandemic has swept across the planet leaving governments, societies, and healthcare systems unprepared and under-resourced. New York City now represents the global viral epicenter with roughly one-third of all mortalities in the United States. ⋯ Such experiences include management of elective and emergent cases, outpatient clinics, physician redeployment, and general health and wellness. As peak infections spread across the United States, we hope this article will serve as a resource for other spine departments on how to manage patient care and healthcare worker deployment during the COVID-19 crisis.
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Open-door laminoplasty often results in postoperative complications such as loss of cervical lordosis, limitations of cervical motion, and axial symptoms. However, current modified laminoplasty techniques such as muscle-sparing type or spinous process splitting technique are not as effective as expected. ⋯ C3 laminectomy combined with modified unilateral laminoplasty is effective for treating patients with multilevel cord compression. This modified technique reconstructs the midline structures and may lead to improved alignment and less axial pain.