Spine
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Fifty-one consecutive patients who underwent extradural sensory rhizotomy for chronic radiculopathy after lumbar surgery were reviewed retrospectively. ⋯ The results of the rhizotomy procedures deteriorated over time. Possible reasons for the failure, other than temporal deterioration, were anatomic factors and lack of specificity of diagnostic techniques, specifically selective nerve root sheath injection. At this point rhizotomy cannot be recommended with any confidence whatsoever in the setting of chronic lumbar radiculopathy after lumbar surgery.
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The use of epidural steroid injections to relieve sciatic pain from spinal stenosis is extremely variable and controversial. Drs. ⋯ Dr. Rydevik believes that epidural steroids might be considered as a nonsurgical alternative, especially in elderly patients where surgery carries greater risk.
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Longitudinal follow-up study of back surgery reoperations using an administrative database. ⋯ The incidence of reoperation after back surgery is independent of diagnosis and type of surgery performed. Despite different anatomic reasons for surgical intervention, the success of different types of surgery are not influenced by the factors identified in this study. More extensive surgery does not prevent nor predispose a patient to the need for further surgery.
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The effect of intraoperative hip position on maintenance of lumbar lordosis was evaluated radiographically in 13 anesthetized patients and 14 unanesthetized volunteers positioned on a Wilson frame (MDT Corp., Torrance, CA). ⋯ Hip flexion was associated with a significant decrease in lordosis in patients and volunteers. Positioning in maximal hip extension optimizes lordosis preservation. While other devices have been shown to have specific effects on lordosis, the Wilson frame can permit easy adjustment of the lumbar sagittal contour to facilitate either preservation or reduction in lordosis.