Journal of spinal disorders & techniques
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J Spinal Disord Tech · Apr 2007
Lumbar spinal osteotomy for kyphosis in ankylosing spondylitis: the significance of the whole body kyphosis angle.
Retrospective analysis of 11 consecutive patients with ankylosing spondylitis who underwent lumbar spinal osteotomy for severe kyphosis, with a mean follow up of 4 (2 to 8.5) years. The chin brow vertical angle, thigh flexion angle, and the whole body kyphosis angle (WBKA) were measured on the clinical photographs of the patient in standing. The lumbar lordosis, thoracic kyphosis, total kyphosis, sacral slope, and sagittal balance were measured on the standing radiographs. ⋯ The WBKA correlated closely with the amount of lordosis correction in lumbar spine. The intraobserver and interobserver reproducibility of the WBKA was verified by statistical analysis. In our opinion the measurement of the WBKA on the preoperative photograph is helpful in planning the lumbar osteotomy.
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J Spinal Disord Tech · Apr 2007
Clinical TrialA minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study.
Among all lumbar disc herniations, L5-S1 far-lateral disc herniations are rare entities. Besides, surgical approach may be difficult because of the very narrow passage at this level. For these 2 reasons, most spine surgeons are not experienced in herniations at this level. According to new microanatomic studies, previous lateral approaches at this level often do not allow access to the neuroforamen without partial or total destruction of the L5-S1 facet joint. To preserve the facet joint, an approach was developed. ⋯ The authors describe a MIIMA for excising herniated discs that is applicable to all types of far-lateral lumbar herniations. Postoperative dysesthesia is the most important complication and may persist as it did in our cases. Consequently, manipulation of the ganglion should be avoided at all costs, if possible. The MIIMA procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone herniated discs in selected cases. This approach is effective, allowing the preservation of the L5-S1 facet joint, saving the facet joint, preventing postoperative instability, and offering a direct view of the L5-S1 neuroforamen.
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J Spinal Disord Tech · Apr 2007
Controlled Clinical TrialCorrelation of spinal canal dimensions to efficacy of epidural steroid injection in spinal stenosis.
To determine a critical canal dimension in patients with spinal stenosis that predicts response to epidural steroid injections (ESI). ⋯ Spinal canal dimension is not predictive of success or failure of ESI in patients with spinal stenosis.
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J Spinal Disord Tech · Apr 2007
Comparative StudyComputer-assisted spinal navigation versus serial radiography and operative time for posterior spinal fusion at L5-S1.
To review the operative time differences between computer-assisted spinal navigation versus serial radiography. ⋯ Image-guided spinal surgery did not cause an increase in operative time. In the best scenario, image navigation saved a statistically significant (P<0.001) amount of time in the operating room. At its worst, fluoroscopy-based image-guided navigation is not significantly different from standard serial radiography.
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J Spinal Disord Tech · Apr 2007
Controlled Clinical TrialBleeding risk with ketorolac after lumbar microdiscectomy.
There is a need to improve postoperative analgesia to support the trend to shorter hospitalization after minimally invasive spine surgeries. Ketorolac Tromethamine has proven efficacy in decreasing postoperative pain but there is concern with postoperative epidural bleeding after spine procedures. We prospectively assessed the incidence of bleeding complications after microdiscectomy in patients treated with a single 30 mg intraoperative dose of Ketorolac subsequent to wound closure. ⋯ Single dose intravenous Ketorolac provided beneficial analgesia without significant increase in risk of bleeding after microdiscectomy, enabling us to consistently perform microdiscectomy as an ambulatory procedure. Meticulous hemostasis should be accomplished before closure. Prolonged postoperative use is a promising alternative to narcotics.