Spine
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A retrospective chart review was conducted for 112 patients who underwent revision posterior lumbar spine decompression, fusion, and segmental instrumentation. ⋯ Number of levels fused and age seem to be the most significant factors predicting hospital stay, operative time, intraoperative blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.
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Case Reports
Dumbbell-shaped meningioma with cystic degeneration in the thoracic spine: a case report.
A case report of dumbbell-shaped meningioma in the thoracic spine with cystic degeneration for which a combined posterior microscopic and anterior thoracoscopic approach was used is described. ⋯ With combined microscopic and thoracoscopic surgery, dumbbell-shaped meningioma could be completely resected. The thoracoscopic approach for the removal of a paravertebral tumor can be a good alternative to thoracotomy.
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Meta Analysis Comparative Study
Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy.
This study involved a search of MEDLINE (1966 to 2000), EMBASE (1980 to 2000), and the Cochrane Controlled Trials Register. The authors of the identified randomized controlled trials were contacted to detect any additional published or unpublished data. The trials selected for this study included all the truly unconfounded or quasi-randomized controlled investigations allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management," or 2) "early decompressive surgery" or "delayed decompressive surgery." Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted the data. ⋯ The data from the reviewed trials were inadequate to provide reliable conclusions on the balance of risk and benefit from cervical spine surgery for spondylotic radiculopathy or myelopathy.
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In a study investigating the correlation between a set of designed criteria and judgments of surgical experience, 100 cervical magnetic resonance images from different patients were used. ⋯ Strong correlations exist between objective measurements and the choice of surgical approach for anterior spine fusion. Among investigated anatomic relations, the instrument manubrial thoracic distance correlated most reliably with the surgeons' choice of the anterior approach. Such objective measurements represent tools that cervical spine surgeons can use to determine the surgical approach.
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Comparative Study
Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation.
A retrospective study of adults with long fusion to the sacrum using three different fixations was performed. ⋯ Attention to sagittal balance is critical in these patients. Revision surgery is as safe and effective as primary surgery. According to the current findings, the Luque-Galveston fixation technique has an unacceptably high rate of pseudarthrosis, and this method is not recommended for adult deformities. Currently, the authors are using bicortical and triangulated sacral screws with an anterior interbody support in patients with good bone stock, but only when the spine balance is restored. Otherwise, they recommend using iliac fixation, although there is a higher rate of painful hardware, requiring removal.