The spine journal : official journal of the North American Spine Society
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The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. ⋯ Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.
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Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other spinal surgeries. Both of these factors have previously been identified as significant risk factors for SSI. We performed a cohort study of this high-risk population to identify risk factors and rates of SSI after spinal osteotomy surgery and identify difference in risk between different types of osteotomies. ⋯ Vertebral column resection has a significant increased risk for SSI (11.1%) compared with other types of osteotomies (4.1%). When possible, osteotomy techniques that involve less extensive exposures and soft-tissue dissection should be chosen to minimize deep SSI risk. Obese patients should be counseled on weight loss to try minimizing superficial SSI risk.
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We previously reported the preliminary results of minimally invasive anterior lumbar interbody fusion (mini-ALIF) with percutaneous pedicle screw fixation (PPF) in 2004. ⋯ The long-term outcome after mini-ALIF with PPF in patients with low-grade isthmic spondylolisthesis was successful. Furthermore, in terms of ASD, there is low incidence of ASD after the procedure.
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Pain drawings have been used extensively in spine surgery. It has been associated with inferior outcome after disc and stenosis surgery. Results regarding the predictive value in fusion surgery have been conflicting. ⋯ A nonorganic pain drawing was a significant risk factor for inferior outcome after spinal fusion surgery. The predictive value did not allow for patient selection.
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Postlaminectomy kyphosis of the cervical spine is a challenging condition to treat because it has a combination of an exposed cord, progressive kyphosis, segmental instability, and anterior neural compression. The ideal mode of surgical correction remains controversial. In terms of surgical strategy, there are few large series that have reported the long-term results of anterior surgical treatment of this condition. ⋯ Our data suggest that multilevel anterior surgical treatment using hybrid decompression (corpectomy and discectomy) combined with instrumented fusion yields acceptable clinical and neurological improvement and effective correction of cervical kyphosis. The techniques used also appeared to decrease the incidence of graft-related complications compared with a previous report by the same author.