Spine
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Patient surveys to determine preferences in surgical decision making. ⋯ Spine surgical patients often prefer to defer surgical decision making to their surgeons. In clinical scenarios where there is little controversy and the evidence is clear, this results in little consequence, assuming that the surgeon aims to provide evidence-based care. In scenarios with greater controversy and less clear evidence, the choice of treatment offered by the surgeon may be based on factors outside of the available science, and, accordingly, efforts should be made to educate fully the patient and to help the patient make his/her own decision based on personal values regarding outcomes.
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A total of 709 skeletally mature atlas specimens were obtained from the Hamann Todd Collection at the Cleveland Museum of Natural History. Using digital caliper, the thickness of the vertebral artery groove was measured to determine the feasibility of potential screw placement. ⋯ Our results suggest that although only a small percentage of patients can accept a screw that is directly inserted via the posterior-lateral arch into the lateral mass, the notching technique is possible in the vast majority of patients. To our knowledge, this is the largest study to examine the possibility of using the posterior-lateral arch as the starting point for these screws. Our results suggest that alternative starting points for these screws are possible in a large percentage of the cases.
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Review Comparative Study
Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety.
Systematic review and meta-regression. ⋯ There is Level III evidence to support balloon kyphoplasty and vertebroplasty as effective therapies in the management of patients with symptomatic osteoporotic vertebral compression fractures refractory to conventional medical therapy. Although there was a good ratio of benefit to harm for both procedures, balloon kyphoplasty appears to offer the better adverse event profile. These conclusions need to be updated on the basis of the findings of ongoing randomized controlled trials.
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Review Case Reports
Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature.
Case description. ⋯ In case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.