The spine journal : official journal of the North American Spine Society
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Combining anterior release and interbody fusion with posterior instrumented fusion is an accepted treatment for severe rigid spinal deformity. Video-assisted thoracoscopic surgery (VATS) and mini-open thoracoscopically assisted thoracotomy (MOTA) are two minimally invasive approaches to the thoracic spine. Both reduce surgical trauma, improve cosmesis and provide effective exposure for release and fusion. Published data and the authors' surgical experience have demonstrated that both techniques are equivalent in degree of release to traditional open thoracotomy, but no comparison between these two minimally invasive alternatives has been published to our knowledge. ⋯ Both approaches resulted in corrections that compare favorably with open thoracotomy. We suggest that a factor in choosing between these two minimally invasive techniques is the number of thoracic levels requiring release. For four levels or less, MOTA provides an excellent alternative to standard thoracotomy. For five or more levels, VATS provides for excellent exposure of additional levels with the advantages of less operative time and blood loss per operated level.
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Randomized Controlled Trial
Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis.
Degenerative lumbar spinal stenosis manifests primarily after the sixth decade of life as a result of facet hypertrophy and degenerative disc disease. Congenital stenosis, on the other hand, presents earlier in age with similar clinical findings but with multilevel involvement and fewer degenerative changes. These patients may have subtle anatomic variations of the lumbar spine that may increase the likelihood of thecal sac compression. However, to the authors' knowledge, no quantitative studies have addressed various radiographic parameters of symptomatic, congenitally stenotic individuals to normal subjects. ⋯ Congenital lumbar stenosis has not been clearly defined radiographically. Clinically, congenitally stenotic patients present at a younger age with fewer degenerative changes and multiple levels of involvement. Radiographically, these patients have a shorter pedicular length and as a result a smaller cross-sectional spinal canal area (mean critical values of 6.5 mm and 213 mm(2) were observed, respectively). The mean critical ratios were 0.43 (2:1 AP vertebral body: pedicle length) on the lateral lumbar radiograph and 0.36 on the sagittal MRI. The altered canal anatomy resulting from a decreased pedicle length may anatomically predispose these patients to earlier complaints of symptomatic neurogenic claudication. Identification of the presence of congenital stenosis should increase the treating surgeon's awareness of the potential need for multilevel treatment.
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Comparative Study Controlled Clinical Trial
Evaluation of the effect of postural perturbation on motoneuronal activity following various methods of lumbar spinal manipulation.
One basic physiologic response to spinal manipulation (SM) is a transient decrease in motoneuronal activity, as assessed by the Hoffmann reflex (H-reflex) technique. However, questions of appropriate control procedures when using the H-reflex technique to study the basic physiologic mechanisms of SM still exist. The identification of appropriate control procedures may allow us to better differentiate among the specific and nonspecific aspects of SM. ⋯ SM may provide procedure-specific sensory input that appears to vary, based upon the various types of vertebral loading applied to the lumbar spine.
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Controlled Clinical Trial
Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status.
Patients with approved workers' compensation injuries receive guaranteed compensation for the duration of their injury, whereas patients with personal injury claims are only compensated, if at all, at the time of a successful settlement or trial verdict at a time point distant from their injury. ⋯ Participants compensated through the workers' compensation system demonstrated a significant loss of days of work as compared with injured patients who received compensation by other means. This may be a reflection of the guaranteed method of compensation afforded to WC patients as opposed to patients who receive no form of financial support (i.e., personal injury) during the recuperative process. Further analysis as to injury severity and a stratification of non-workers' compensation reimbursement methods are needed to further improve the validity of this study.
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There is limited information describing the correlation between the initial quantitative measurements on magnetic resonance imaging (MRI) scans of disc herniation area, canal cross-section areas, percent canal compromise, and disc herniation location to the need for surgery. ⋯ Our findings show a trend for patients treated with surgery to have larger disc herniation areas and smaller canal cross-section areas, corresponding to larger percent canal compromise than the nonoperative group. Centrally located herniations followed this trend closely at all levels studied. However, the paracentral herniation at the L4-5 level does not follow this trend, possibly because paracentral disc herniation clinical course is determined more by herniation location rather than the overall herniation size.