Spine
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Peer-reviewed literature was reviewed and summarized. ⋯ A successful arthrodesis is the fundamental surgical goal for patients with chronic pain of spinal origin. However, a successful fusion does not always correlate with a successful clinical result.
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The literature and current research related to spinal pain mechanisms were reviewed, as well as animal models related to its study. ⋯ Areas of continued research are highlighted that may help guide the management of painful spine symptoms and syndromes.
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A literature review and synthesis were performed. ⋯ Some clinical or experimental support can be found in the literature for 10 specific mechanisms or proposed mechanisms of spinal cord stimulation.
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An anatomic study of pedicle dimensions and orientation was performed for upper thoracic vertebrae from elderly human subjects. ⋯ Even the largest patients had some pedicles that could not accommodate the smallest standard pedicle screw, and more than one half of the pedicles average patients were too small. Transpedicular screw placement is not safe in these patients. Proper placement must avoid penetration of the medial pedicle wall.
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Case Reports
Metformin-associated lactic acidosis after elective cervical spine fusion: a case report.
A case of metformin-associated lactic acidosis after elective spinal surgery is reported. ⋯ Spinal surgeons should be aware of this preventable, potentially fatal side effect and stop metformin 48 hours before surgery.