Spine
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Review
Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review.
Systematic review. ⋯ Moderate- and high-GRADE evidence for nonoperative treatment is lacking and thus prohibiting recommendations to guide clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.
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We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs. ⋯ Gaps are evident in existing methods and a new framework to identify patients with neck pain and back pain in administrative data is proposed.
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Review Case Reports
Cervical myelopathy after cervical total disc arthroplasty: case report and literature review.
Case report and literature review. ⋯ On the basis of presented cases and other reports, the surgical goals in these patients were prioritized as follows: (1) safe and adequate neurological decompression and (2) establishment and maintenance of cervical sagittal balance. Moreover, a criterion for selecting patients undergoing CTDA needs to be established in order to reduce the occurrence of neurological complications associated with the procedure.
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Review Case Reports
Pediatric noncontiguous spinal injuries: the 15-year experience at a level 1 trauma center.
Retrospective review. ⋯ There is a high incidence of children with multiple NCSI who are more likely to experience neurological injuries compared with patients with single-level or contiguous spinal injuries. Patients with a single-level spinal injury on existing imaging with an associated neurological injury should undergo at least plain films of the entire spine to exclude noncontiguous injuries. In patients without neurological injury and a single spinal fracture, radiography showing at least 4 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.
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A 3-dimensional finite element model of 2 lumbar motion segments (L4-L5 and L5-S1) was used to evaluate the sensitivity of lumbar total disc replacement (TDR) impingement to disc height distraction, spinal sagittal orientation, implant position, and implant lordosis. The models were implanted with a mobile-bearing TDR and exposed to simulated sagittally balanced erect posture. ⋯ The data from this study indicate that lumbar mobile-bearing TDR impingement is sensitive to disc height distraction, anterior-posterior position, implant lordosis, and spinal sagittal orientation. TDR impingement risk can be minimized by choosing an implant with an appropriate amount of lordosis, not overdistracting the disc space, and taking care not to place the implant too far anterior or posterior.