Journal of neurosurgery. Spine
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The Saskatchewan Spine Pathway (SSP) was introduced to improve quality and access to care for patients with low-back and leg pain in the province. There is very limited data regarding the efficacy of nonsurgeon triage of surgical referrals. The objective of this early implementation study was to determine how the SSP affects utilization of MRI and spine surgery. ⋯ The SSP significantly reduced MRI utilization and referrals seen by the surgeon for nonoperative care. Although this early implementation study suggests potential for cost savings, a more rigorous analysis of outcomes, costs, and patient satisfaction is required.
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Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. ⋯ At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas.
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The Estimation of Physiological Ability and Surgical Stress (E-PASS) and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems are surgical risk scoring systems that take into account both the patient's preoperative condition and intraoperative variables. While they predict postoperative morbidity and mortality rates for several types of surgery, spinal surgeries are currently not included. The authors assessed the usefulness of E-PASS and POSSUM algorithms and compared the predictive ability of both systems in patients with spinal disorders considered for surgery. ⋯ As E-PASS predicted morbidity more correctly than POSSUM, it is useful for estimating the postoperative risk of patients considered for spinal surgery.
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Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure. The authors' goals were therefore to ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections. ⋯ This study identifies that several factors--older age, diabetes, obesity, prior spine surgery, and length of hospital stay--were each independently associated with an increased risk of developing infection among patients undergoing instrumented lumbar fusion for degenerative spine disease. The overwhelming majority of these patients were treated effectively without hardware removal.
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Biomechanical studies have shown that anterior cervical fusion construct stiffness and arthrodesis rates vary with different reconstruction techniques; however, the behavior of the adjacent segments in the setting of different procedures is poorly understood. This study was designed to investigate the adjacent-segment biomechanics after 3 different anterior cervical decompression and fusion techniques, including 3-level discectomy and fusion, 2-level corpectomy and fusion, and a corpectomy-discectomy hybrid technique. The authors hypothesized that biomechanical changes at the segments immediately superior and inferior to the multilevel fusion would be inversely proportional to the number of fused bone grafts and that these changes would be related to the type of fusion technique. ⋯ At segments adjacent to the fusion level, biomechanical changes are not limited solely to the discs, but also propagate to the posterior facets. These changes in discs and posterior facets were found to be lower for discectomy than for corpectomy, thereby supporting the current study hypothesis of inverse relationship between the adjacent-segment variations and the number of fused bone grafts. Such changes may go on to influence the likelihood of adjacent-segment degeneration accordingly. Further studies are warranted to identify the causes and true impact of these observed changes.