The spine journal : official journal of the North American Spine Society
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Pre-existing comorbid psychiatric mood disorders are a known risk factor for impaired health-related quality of life and poor long-term outcomes after spine surgery. ⋯ Patients with preoperative psychiatric mood disorders undergoing elective cervical surgery had worse NDI scores and received more opioid prescriptions, despite similar VAS scores as those without mood disorders. Lumbar surgery patients with mood disorders were demographically different than those without mood disorders and had worse pain before and after surgery, though ODI scores were not different. Tobacco use was the sole contributor to postoperative VAS pain scores. This information can be useful in counseling patients with mood disorders before elective spinal surgery.
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Compared with other approaches, anterior lumbar interbody fusion (ALIF) is believed to be more effective at restoring segmental lordosis and reducing risks of adjacent-segment disease. It remains controversial, however, whether ALIF improves global lumbar lordosis or influences pelvic parameters, possibly because of the heterogeneity of implants and levels studied. ⋯ Stand-alone mini-ALIF with anterior plate fixation for L5-S1 can change pelvic parameters while improving global and segmental lumbar lordosis. The procedure resulted in a fusion rate of 96% and comparable improvements in ODI to other studies.
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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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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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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.