European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Observational Study
Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing.
Quantitative sensory testing (QST) gained popularity to evaluate the time course of recovery in sensory dysfunction and the results of different treatment options. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders. For this purpose, we hypothesised that there are also comparable differences in pain patterns in men and women after lumbar sequestrectomy using QST. ⋯ Our results clearly revealed pre- and postoperative differences in pain perception between genders. These differences have to be taken into account in the evaluation of outcome between genders. Therefore, QST seems to be a good method to evaluate the time course of recovery after surgery.
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To determine perioperative characteristics of patients undergoing single-level spinal fusion surgery that could help predict discharge to an inpatient rehabilitation facility (IRF). ⋯ Statistically significant differences were seen regarding age, BMI, CCI, LOS and insurance provider when determining the necessity of a patient being discharged to an IRF. These characteristics can be used to begin the process of setting up discharge disposition preoperatively rather than postoperatively. There were no perioperative characteristics that were statistically significant in determining discharge disposition; therefore, physicians can utilize these preoperative demographics in deciding and organizing discharge before the day of surgery, which can diminish LOS and lead to substantial health system savings.
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Case Reports
Return of motor evoked potentials after knee flexion in the setting of high-grade spondylolisthesis.
To present a case of loss of motor-evoked potentials (MEPs) to the left foot in the supine position after a partial reduction and instrumented fusion from L4 to pelvis which was managed successfully without revision or removal of implants. ⋯ IV.
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A radiographic study to analyze the working zone and relationship of the nerve root to their corresponding intervertebral disc for transforaminal percutaneous approaches. ⋯ At lower lumbar levels the exiting nerve root is at risks of injury. Hence, it is advised to enlarge the foramen for safe passage of endoscopic instruments and to minimize the possibility of nerve injury.
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Total disc arthroplasty can be a viable alternative to fusion for degenerative disc disease of the lumbar spine. The correct placement of the prosthesis within 3 mm from midline is critical for optimal function. Intra-operative radiographic error could lead to malposition of the prosthesis. The objective of this study was first to measure the effect of fluoroscopy angle on the placement of prosthesis under fluoroscopy. Secondly, determine the visual accuracy of the placement of artificial discs using different anatomical landmarks (pedicle, waist, endplate, spinous process) under fluoroscopy. ⋯ A fluoroscopy angle of 7.5° or more can lead to implant malposition greater than 3 mm. The pedicle is the most accurate of the anatomic landmarks studied for placement of total artificial discs in the lumbar spine.