Spine
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Prospective cross-sectional blinded-assessor cohort study. ⋯ The inter-rater reliability of total mJOA and its subscores is good, except for UE sensory function (moderate). However, the vast majority of assessments differed between observers, indicating that this measure should be interpreted carefully, particularly when near the threshold between severity categories, or when a patient is reassessed for deterioration. Further efforts to educate clinicians on administration and to refine the UE sensory subscore may enhance the reliability of this tool.Level of Evidence: 1.
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Multicenter Study
A Risk Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery.
Retrospective review of a prospectively enrolled multicenter Adult Spinal Deformity (ASD) database. ⋯ Increasing invasiveness is associated with increased odds of major complications and reoperations. Risk-benefit cutoffs for successful outcomes were 79.3 for NF, 111 for F, and 53.3 for SF patients. Above these, increasing invasiveness has increasing risk of major complications or reoperations and not meeting MCID at 3Y.Level of Evidence: 3.
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Retrospective cohort study. ⋯ Decompression and DS surgery for LSS with or without spondylolisthesis showed favorable long-term surgical outcomes with an acceptable rate of complications and ASD. However, an improved physiological DS system should be developed.Level of Evidence: 4.
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Biomechanical cadaveric study. ⋯ IVD degeneration is related to notable load-redistributions between the passive spinal structures. With further degeneration, reduced contribution of the LF and PLL and higher loads on the IVD are observed in flexion. In the other tested loading directions, the relative load on the IVD is reduced, whereas higher FJ-exposure in axial rotation, anterior and lateral shear is observed. Furthermore, the preload of the spinal structures is reduced. These observations can further the understanding of the degenerative cascade in the spine.Level of Evidence: N/A.
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Randomized Controlled Trial
Equal Ratio Ventilation Reduces Blood Loss During Posterior Lumbar Interbody Fusion Surgery.
A prospective randomized double-blinded study. ⋯ Compared to conventional ratio ventilation, ERV provided lower PIP and reduced intraoperative surgical blood loss in patients undergoing PLIF surgery.Level of Evidence: 2.