Spine
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Review
Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes.
Review of published literature. ⋯ More studies designed to provide class I or II data will be needed in the future to further solidify the favorable results observed so far with the MIS TLIF procedure.
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Literature review. ⋯ With these relatively simple modifications to surgical technique, significant improvements in intraoperative blood loss, postoperative pain, surgical morbidity, return of function, among others, have been achieved. However, MIS techniques remain technically demanding and a significant complication rate has been observed during the initial learning curve of the procedures.
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A case report and review of the literature. ⋯ The diagnostic challenge presented by this case, especially considering the rarity of paraspinal compartment syndrome, indicates the need for a high index of suspicion in the appropriate setting.
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Review of the literature with analysis of pooled data. ⋯ As spine surgery, and patient comorbidity, becomes increasingly complex, IOM permits more aggressive deformity correction and tumor resection. Combination of SSEP and MEP monitoring provides assessment of entire spinal cord functionality in real time. Spontaneous and triggered electromyography add assessment of nerve roots. The wake-up test can continue to serve as a supplement when needed. MIOM may prove useful in preservation of neurologic function where an alteration of approach is possible. IOM is a valuable tool for optimization of outcome in complex spinal surgery.
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Literature review. ⋯ An appropriate SOC as it relates to neuromonitoring is difficult to devise because of national variance with regard to qualifications of neurophysiologic technical and professional personnel, different levels of training and certification, and anesthesia protocols. A unified group of surgeons working in collaboration with a multidisciplinary group of experienced doctoral level nonphysician and physician professional surgical neurophysiologists is needed to define a protocol for providing and interpreting such data. In addition to ensuring that only the most qualified and experienced personnel are delivering and/or interpreting neuromonitoring services, surgeons, hospital administrators, and insurance company medical directors need to understand the different service delivery models and their respective strengths and limitations with particular attention to the qualifications and competencies of all respective parties. Only then can a well-defined SOC be established, thus improving the treatment of surgical patients for whom neuromonitoring is required.