The spine journal : official journal of the North American Spine Society
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Inadvertent perforation of the C0-C1 and C1-C2 joints is one of the potential complications of C1 screw insertion. ⋯ When the screw is directed between 0 degrees and 15 degrees medially, it can be inserted without C0-C1 and C1-C2 joint violation if the screw tip trajectory lies between the 20% and 40% points of the anterior atlas arch.
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Although there are several studies evaluating the necessity and efficacy of thromboprophylaxis after spinal trauma with or without spinal cord injury (SCI), to date there is no established standard of practice pertaining to this specific patient population with regards to venous thromboembolism (VTE) prophylaxis. ⋯ Postoperative pharmacologic thromboprophylaxis was opined to be unnecessary in patients with cervical spine injuries without SCI, however, it is recommended for cervical spine trauma with SCI or anterior thoracolumbar procedures irrespective of SCI. Pharmacologic thromboprophylaxis was recommended to start preoperatively as soon as possible in SCI cases or in cases with surgical delay. Pharmacologic prophylaxis was recommended to be administered for at least 3 months postinjury. Although these recommendations met complete consensus by this group, individual patient factors should also be considered in determining optimal thromboprophylaxis in this patient population. Future research recommendations on thromboprophylaxis in spinal trauma are proposed.
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The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remain unclear. ⋯ The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a threefold higher risk of experiencing LBP.
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Severe adolescent idiopathic scoliosis with respiratory insufficiency is infrequently seen in North America currently. ⋯ A staged anterior and posterior VCR with intervening halo-gravity traction is a viable option to treat severe scoliosis in patients with restrictive pulmonary function.
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Interspinous process devices represent an emerging treatment for neurogenic intermittent claudication resulting from lumbar spinal stenosis. Most published descriptions of the operative technique involve treatment of patients in the modified lateral decubitus knee-chest position (modified lateral decubitus), and yet many surgeons have begun to perform the procedure in various prone positions. The patient's positioning on the operating room table seems likely to influence resting interspinous distance, and thus implant sizing and possibly the risk of intraoperative spinous process fracture. The intersegmental lumbar effect of variants on operative prone positioning compared with the modified lateral decubitus position has not been studied. ⋯ Prone positioning of patients in flexion on the operating table using the Andrews table or Wilson frame resulted in similar lumbar interspinous distance compared with the modified lateral decubitus position. Prone positioning on the Jackson frame resulted in statistically less interspinous distance than all other positions. Positioning on the Andrews table resulted in similar segmental angulation to the modified lateral decubitus position. Extrapolation from these data, obtained in healthy males younger than the typical age of patients treated with interspinous distraction devices, should clearly be done with caution. However, it seems reasonable to suggest that performing these procedures in the prone position using the Andrews table (greatest interspinous distance) is unlikely to result in the placement of significantly undersized implants, or significantly increase the force required to insert an implant.