Spine
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A cost-effectiveness analysis of lumbar discectomy based on existing efficacy data and newly gathered cost data. ⋯ For carefully selected patients with herniated discs, surgical discectomy is a cost-effective treatment. Discectomy's favorable cost-effectiveness results from its substantial effect on quality of life and moderate costs.
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The case report presented herein shows tortuosity of the vertebral artery in a patient with cervical myelopathy. This case led the authors to evaluate 22 other patients who also had undergone anterior cervical fusion. They were studied before operation by either magnetic resonance imaging angiography or selective vertebral angiography. ⋯ This study suggests that vertebral artery loop formation is developed associated with cervical spondylotic changes. During the anterior decompression of cervical spondylotic myelopathy or radiculopathy, the looped vertebral artery could be injured by an excessive wide rejection of the bone or disc material. In the case of vertebral artery migration, the looped vertebral artery can even be injured by routine procedures.
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This study analyzed bony features of the posterior ilium and relevant vital structures using cadavers and dry ilium specimens. ⋯ The ideal area of the posterior ilium for bone graft harvesting was found in Zone 1. Zones 2 or 3 may be considered it a greater quantity of cancellous bone graft is required; however, the risk of injury to the sacroiliac joint and superior gluteal vessels in these zones is increased.
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Multicenter Study Clinical Trial Controlled Clinical Trial
Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years' follow up.
Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. ⋯ Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.
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Lumbosacral nerve roots and dorsal root ganglia in relation to surrounding bony structures in normal subjects were investigated using magnetic resonance imaging. ⋯ The anatomy of the lumbar nerve roots and dorsal root ganglia and their relations to bony structures have been better defined in this study. Because of its more medial location, S1 radiculopathy may involve both the nerve root and dorsal root ganglion as a result of either disc herniation or degenerative L5-S1 facet changes. The relatively larger dorsal root ganglia and the greater dorsal root ganglion/foramen height ratios in the lower lumbar region may explain the higher incidence of L5 or S1 radiculopathy, particularly given the propensity to disc degeneration and intervertebral foraminal narrowing in the lower lumbar region.