Articles: surgery.
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Comparative Study
Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws.
Prospective clinical study with postoperative radiologic control of pedicle screw placement in the cervical spine. ⋯ Transpedicular screws in the cervical spine and cervicothoracic junction can be applied safely and with high accuracy in a conventional technique. Cannulated screws and the use of separate stab incisions from C3-C6 with a trocar system allow for reduced screw misplacement rates. The CAS system leads to significantly reduced screw misplacement rates. Therefore, because of the potential risk of injury to the vertebral artery and neural elements, the use of a CAS system seems to be beneficial, especially for pedicle instrumentation C3-C6.
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Zhonghua Wai Ke Za Zhi · Oct 2005
Comparative Study[Accuracy of CT-based navigation of pedicle screws implantation in the cervical spine compared with X-ray fluoroscopy technique].
To evaluate the feasibility and accuracy of cervical spine pedicle screw fixation assisted by X-ray fluoroscopy and CT-based navigation system. ⋯ CT-based navigation system can increase the accuracy of cervical pedicle screw implantation significantly.
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The aim of this article is to review current practice of spinal anesthesia regarding technique and medication use; review recent applications of spinal anesthesia to subspecialty care in outpatient, cardiac, and obstetrical anesthesia; and update risk assessment associated with spinal anesthesia. ⋯ Innovations in technology, equipment, and needle design improved safety and decreased complication rates from spinal anesthesia. The increased popularity of ambulatory surgical procedures has resulted in more frequent use of spinal anesthesia. Intrathecal narcotic analgesia is used increasingly in fast-tracking cardiac surgical protocols. Modern anesthetic and analgesic techniques include resurgence of older agents (2-chloroprocaine) as well as new agents (levobupivacaine and ropivacaine) that are used in conjunction with adjuvant intrathecal medications (opioids, vasopressors, and alpha-2 adrenergic agonists). Surgical thromboprophylaxis and the increased use of anticoagulants in patients with cardiovascular disease have challenged anesthesiologists to update clinical guidelines to minimize the risk of hemorrhagic complications such as epidural hematoma. The risk/benefit ratio of spinal anesthesia should be individualized. The continued popularity of spinal anesthesia is due to the safety, effectiveness and efficiency of this technique.
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Objectives. Recent publications on dual program spinal cord stimulation (SCS) system demonstrate more flexible electrode programming, which helps to steer paresthesias towards all of the affected areas including the low back area. Materials and Methods. The following data were retrospectively sought from 20 nonrandomized failed back surgery patients at two centers treated by a dual quadripolar surgically implanted SCS lead: pain and paresthesia, VAS ratings, medication use, sleep patterns, daily activities, hardware problems, and willingness to repeat the procedure. The data were analyzed by the Wilcoxon signed rank test (p value < 0.05). ⋯ The number of patients taking benzodiazepines decreased. Sixty percent reported increased participation in social activities. Conclusions. This dual program surgical SCS technique is simple, respects patients' autonomy, and provides adequate analgesia with an increase in quality of life.
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Case Reports
Image-guided transsacral approach to presacral lesions of nerve root origin: technical note.
The utility of image guidance in fashioning a posterior transsacral operative corridor for approaching small presacral neural lesions has not previously been reported. ⋯ An image-guided transsacral approach is a viable option for accessing small to moderately sized lesions of nerve root origin located within the presacral space.