The spine journal : official journal of the North American Spine Society
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Despite the interest in lumbar spinous process (SP)-based surgical innovation, there are no large published studies that have characterized the morphometry of lumbar SPs. ⋯ This large cadaveric study provides level-specific morphometric data regarding the osseous dimensions of lumbar SPs relevant to techniques and devices targeting the lumbar SPs or the interspinous space. Of particular importance is the recognition that L5 has relatively different morphology when compared with more cranial levels. Potentially important differences were noted comparing women with men, black with white, and aging populations.
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Randomized Controlled Trial Comparative Study
The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial.
Pedicle screws (PS) offer great benefits in posterior lumbar interbody fusion (PLIF), but several drawbacks of PS, including the risk of superior facet joint violation and muscle injury, have also pointed out. Recently, cortical screws (CS) were invented, which can be placed without the drawbacks associated with PS. However, whether CS in PLIF can provide similar or greater clinical and radiologic outcomes compared to those of PS has not been fully evaluated in clinical research studies. ⋯ CS in PLIF provides similar clinical and radiologic outcomes compared to PS in PLIF. On the basis of the present study, we suggest CS to be a reasonable alternative to PS in PLIF.
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Randomized Controlled Trial
Postdural puncture headache: impact of needle type, a randomized trial.
The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. ⋯ We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.
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The favorable outcome of surgical treatment for degenerative lumbar spondylolisthesis (DS) is widely recognized, but some patients require reoperation because of complications, such as pseudoarthrosis, persistent pain, infection, and progressive degenerative changes. Among these changes, adjacent segmental disease (ASD) and same segmental disease (SSD) are common reasons for reoperation. However, the relative risks of the various factors and their interactions are unclear. ⋯ The incidence of reoperation in patients surgically treated for DS was 23.2% at a mean time of 5.9 years. A significantly higher incidence of reoperation was observed in patients treated with decompression alone compared with those treated with decompression and fusion. Body mass index and disc height were identified as independent risk factors for SSD, whereas male gender and facet degeneration were identified as independent risk factors for ASD. The results of this comprehensive review will guide spine surgeons in their preoperative planning and in the surgical management of patients with DS, thereby reducing the reoperation rate.
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Although direct repair (DR) with screw fixation at the pars defect is a common surgical treatment for lumbar spondylolysis, it is unknown whether DR leads to better outcomes for young patients with spondylolysis than traditional nonsurgical treatment. ⋯ Conservative treatment for young patients with spondylolysis may produce similar clinical outcomes and fewer complications over 12-month follow-up than surgical treatment with DR.