The spine journal : official journal of the North American Spine Society
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Patients with back dominant pain generally have a worse prognosis after spine surgery when compared with patients with leg dominant pain. Despite the importance of determining whether patients with lumbar spine pain have back or leg dominant pain as a predictor for success after decompression surgery, there are limited data on the reliability of methods for doing so. ⋯ A patient's ability to identify whether his or her lumbar spine pain is leg or back dominant may be unreliable and depends on which questions are asked, and also how they are asked. The Percent question is the most reliable method to determine the dominant location of pain. However, given the variability of responses and the generally poorer reliability of many specific questions, it is recommended that multiple methods be used to assess a patient's dominant location of pain.
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The prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven. ⋯ This study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.
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Studies have suggested that the use of bone marrow aspirate (BMA) with HEALOS (DePuy Spine, Raynham, MA), a collagen-hydroxyapatite sponge (CHS), is an effective substitute for autologous iliac crest bone graft when used in fusion procedures of the lumbar spine. ⋯ At the 2-year follow-up, BMA/CHS showed acceptable fusion rates in patients undergoing TLIF/PLF, and can be considered as an alternative source of graft material.
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Case Reports
An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle.
It has been reported that compression of the sciatic nerve because of any cause, including endometriosis, piriformis syndrome, abscess, tumor, adjoining uterus provoke sciatic pain. Some of these pathophysiologies have been diagnosed clinically and sometimes by exclusion. ⋯ Although it may not be common, compression of the sacral plexus caused by dynamic motion of the obturator internus muscle should be included as a possible diagnosis for sciatic pain.
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Case Reports
Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion.
Urologic, gynecologic, and colorectal surgical procedures account for most of the iatrogenic ureteral injuries; however, iatrogenic injury secondary to thoracolumbar spinal surgery remains a rare complication. ⋯ Although an iatrogenic ureteral injury secondary to thoracolumbar surgery is rare, it should be included in the differential diagnosis for a patient presenting with flank pain after undergoing lateral thoracolumbar fusion. A urinoma, also an uncommon occurrence, may be a presenting sign. Prompt diagnosis and institution of appropriate corrective surgical procedures may result in successful outcome.