Journal of neurosurgery. Spine
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Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. ⋯ In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P/TLIF.
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Comparative Study
A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors.
Standard approaches to thoracic intradural tumors often involve a large incision and significant tissue destruction. Minimally invasive techniques have been applied successfully for a variety of surgical decompression procedures but have been rarely used for the removal of intradural thoracolumbar tumors. In this paper, the authors compare the clinical outcome of mini-open resection of intradural thoracolumbar tumors with a standard open technique. ⋯ The mini-open approach allows for adequate treatment of intradural thoracolumbar tumors with comparable outcomes to standard, open approaches. The mini-open approach is associated with less blood loss and a shorter length of stay compared with standard open surgery.
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Surgical results in cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) evaluated with a patient-based method have not yet been reported. The purpose of this study was to examine patient satisfaction with surgery for cervical myelopathy due to OPLL and to clarify factors related to satisfaction. ⋯ Eighty percent of patients were satisfied with the surgical results after treatment of cervical myelopathy due to OPLL. Surgery for cervical OPLL was effective, as evaluated by both doctor- and patient-based methods. Patient satisfaction was related to QOL, PF (especially LEF), and improvement.
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Case Reports
Rhabdomyolysis and acute renal failure following minimally invasive spine surgery: report of 5 cases.
Minimally invasive spine surgery is increasingly used to treat various spinal pathologies with the goal of minimizing destruction of the surrounding tissues. Rhabdomyolysis (RM) is a rare but known complication of spine surgery, and acute renal failure (ARF) is in turn a potential complication of severe RM. The authors report the first known case series of RM and ARF following minimally invasive lateral spine surgery. ⋯ Rhabdomyolysis is a rare but known potential complication of spine surgery. The authors describe the first case series associated with the minimally invasive lateral approach. Surgeons must be aware of the possibility of postoperative RM and ARF, particularly in morbidly obese patients and in procedures associated with prolonged operative times.
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The object of this study was to determine if the addition of transverse connectors (TCs) to a rod-screw construct leads to increased stabilization of the cervical spine. ⋯ Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none.