The spine journal : official journal of the North American Spine Society
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Case Reports
Somatosensory evoked potential monitoring of lumbar pedicle screw placement for in situ posterior spinal fusion.
Somatosensory evoked potentials (SSEP) are commonly used to monitor the spinal cord and nerve roots during operative procedures that put those structures at risk. The utility of SSEPs to evaluate cauda equina and nerve root function during posterior spinal arthrodesis with pedicular fixation for degenerative lumbar disease has been reported anecdotally and remains controversial. ⋯ We conclude that the use of SSEPs in evaluating pedicle screw placement during lumbar arthrodesis is limited. In this setting, if monitoring is required, alternative methods with greater sensitivity and efficacy should be explored.
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The use of interbody fusion cages as a treatment for degenerative disc disease has become widespread. Low-profile cages have been developed to allow a closer fit when implanting bilateral cages in patients with smaller vertebral bodies. Some surgeons feel the open design also allows better bone contact and visualization. This is particularly true when two low-profile cages are used adjacent to one another. Because of the open design of low-profile interbody fusion cages, there has been concern regarding such issues as subsidence, lordosis and fusion rates. ⋯ Bilateral implantation of low-profile cages in this patient population led to satisfactory outcomes. Subsidence and changes in lordosis were minimal. Fusion rates were good, especially for one-level cases. Patient satisfaction was relatively high, considering the population consisted of 96% worker's compensation cases. With proper surgical technique, bilateral low-profile cages can be used effectively to treat patients with degenerative disc disease.
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Chronic zygapophyseal joint arthropathy is a cause of back and neck pain. One proposed method of treating facet joint pathology is ablation of medial branches and dorsal rami with pulsed radiofrequency (RF) waves. ⋯ The results of our study showed that the application of pulsed RF to medial branches of the dorsal rami in patients with chronic facet joint arthropathy provided temporary pain relief in 68 of 118 patients.
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This is a synopsis of a symposium presented to the North American Spine Society Annual Meeting in Montreal, Canada, 2002. ⋯ Spine surgeons must be aware of the common causes of FBSS in order to be able to thoroughly evaluate their patients and to minimize the occurrence of this problem.