Spine
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Systematic literature review. ⋯ Postoperative ION after spinal surgery is a rare event, which may be associated with prone position surgery of more than 5 hours surgical duration and blood loss of more than 1 L. Informing patients of this remote risk should be considered during preoperative counseling. The quality of evidence for preventative measures for postoperative ION after spinal fusion surgery is very low, but it has been proposed that efforts aimed at reducing the duration or severity of venous congestion in the head may be beneficial.
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Systematic review. ⋯ (1) Compared to open techniques, MAS does not decrease the rate of complications for posterior lumbar spinal decompression or fusion. (2) There is no evidence to assess the effectiveness of strategies to reduce the risk of MAS-related complications.
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Systematic review. ⋯ Wrong site surgery may be preventable. We suggest that the North American Spine Society and JC checklists are insufficient on their own to minimize this complication. Therefore, in addition to these protocols, we recommend intraoperative imaging after exposure and marking of a fixed anatomic structure. This imaging should be compared with routine preoperative studies to determine the correct site for spine surgery.
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Systematic review. ⋯ We undertook systematic reviews to establish a baseline of the current evidence on patient safety issues in spine surgery. This article reports the methods used in the reviews.
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The objective of this article was to undertake a systematic review of the literature to determine whether IOM is able to sensitively and specifically detect intraoperative neurologic injury during spine surgery and to assess whether IOM results in improved outcomes for patients during these procedures. ⋯ Based on strong evidence that multimodality intraoperative neuromonitoring (MIOM) is sensitive and specific for detecting intraoperative neurologic injury during spine surgery, it is recommended that the use of MIOM be considered in spine surgery where the spinal cord or nerve roots are deemed to be at risk, including procedures involving deformity correction and procedures that require the placement of instrumentation. There is a need to develop evidence-based protocols to deal with intraoperative changes in MIOM and to validate these prospectively.