The spine journal : official journal of the North American Spine Society
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Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. ⋯ Computer-assisted spinal surgery has the potential to reduce reoperation rates and thus to have serious cost-effectiveness and policy implications. High acquisition and maintenance costs of this technology can be offset by equally high reoperation costs. Our cost-effectiveness analysis showed that for high-volume centers with a similar case complexity to the studied population, this technology is economically justified.
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Although the negative aspects of blood transfusion are increasingly recognized, less is known about transfusion-related risks in spinal surgery. ⋯ Allogeneic blood transfusion after elective lumbar surgery was associated with increased risks of SSI and urinary tract infection.
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Rapidly progressing extrinsic spinal cord compression syndromes are rare, especially when the compression is associated with the supine position. ⋯ To our knowledge, no other case of spinal protection shield in compressions caused by the supine position have been studied. The surgical and technical management therefore remains innovative.
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Observational Study
The importance of identifying and modifying unemployment predictor variables in the evolution of a novel model of care for low back pain in the general population.
Care for low back pain (LBP) is costly, fragmented and, in non-compensation populations, rarely specifically addresses factors associated with maintaining employment status or return to work (RTW). ⋯ From a societal perspective, employment status as an outcome measure is paramount in assessing the value of a new model of care for LBP. Mitigation strategies for the predictor variables identified will be included in ISAEC pathways to translate clinical improvement into societal added value.
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The anterior-only surgical procedure is used as a recommended approach in the treatment of cervical facet dislocations, but an anterior cervical spine implant that offers higher three-column instabilities for stronger fixation is lacking. ⋯ Anterior pedicle screw and plate fixation represents a safe and efficacious but technically challenging option for the treatment of cervical facet dislocations.