Spine
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A retrospective study. ⋯ In this study, longitudinal displacement of the pelvis, transverse sacral fracture, and trauma from a suicidal jump were risk factors for lumbosacral plexus palsy. These risk factors were helpful in our examination of patients who had severe pelvic fracture with loss of consciousness.
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Biomechanics of normal vertebral segments adjacent to a degenerated segment in the cervical spine. ⋯ The hypothesis of higher motion changes in the normal C6-C7 segment immediately inferior to a degenerated C5-C6 segment was found to be true. Future experiments on multisegmental cervical spines are recommended to verify the current data.
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Analysis of the effect of antifibrinolytics on in vitro bone formation. ⋯ These findings demonstrate that the antifibrinolytics have drastically different effects on osteoblasts due in part to different efficacies of protease inhibition. Further, this work suggests that the fibrinolytic proteases and their inhibitors have great potential to regulate bone by affecting the processes that control osteoblast growth and differentiation.
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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. ⋯ There is no consensus definition of significant hemorrhage in adult spine fusion surgery. However, definition in the anesthesiology literature of massive blood loss is somewhat arbitrary but is commonly accepted to entail loss of 1 volume of the patient's total blood (60 mL/kg in adults) in <24 hours. On the basis of the current literature, there is little support for routine use of CS during elective spinal surgery. Concerns related to the use of aprotinin were such that our panel of experts unanimously recommended against its use in spine surgery on the basis of the reports of increased complications. With respect to the antifibrinolytics of the lysine analog class (tranexamic acid and aminocaproic acid), on the basis of the available efficacy and safety data, we recommend that they be considered as possible agents to help reduce major hemorrhage in adult spine surgery.