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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Review Case Reports
Management of a posterior gunshot injury with a floating pedicle and cerebrospinal fluid leak.
Gunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade. ⋯ Literature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.
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Lumbar fusion for degenerative disorders is among the most common spine surgical procedures performed. The purpose of this study was to analyze fusion, complications, and clinical success for lumbar fusion performed with various surgical techniques as reported in the literature from 2000 to 2015 and compare with previous critical analysis of outcomes from 1980 to 2000. ⋯ Lumbar fusions for degenerative disorders from 2000 to 2015 demonstrate a trend toward more interbody fusions and MIS techniques than prior decades. Clinical success with MIS appears more likely than with non-MIS fusions, despite equivalent fusion and complication rates. While these data are intriguing, they should be interpreted cautiously considering the level of heterogeneity of the studies available. Further, high-quality comparative studies are warranted to better understand the relative benefits of more complex interbody and MIS fusions for these conditions. These slides can be retrieved under Electronic Supplementary Material.
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Posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) can have complications that require reoperation. The goal of the study was to identify risk factors for reoperation within 2 years after PLIF/TLIF. ⋯ Surgical invasiveness, as reflected by number of fused levels, operation time, EBL and dural tear, was associated with reoperation. Fusion of two or more levels is a strong risk factor for reoperation within 2 years after initial PLIF/TLIF. These slides can be retrieved under Electronic Supplementary Material.
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Iliac crest has long been the gold standard for lumbar fusion, but concerns over donor site morbidity have led to a wide variety of bone graft substitutes. Despite prolific research, a general consensus is yet to be reached on bone graft materials that lead to optimal fusion. ⋯ While our results find that LAG+BMA provided highest fusion rate, most material options analyzed in this study provide comparable fusion outcomes. The ideal graft option must incorporate a combination of materials with osteoconductive, osteoinductive, and osteogenic properties. Our results represent the robust and dynamic nature of the current state of lumbar graft technology. These slides can be retrieved under Electronic Supplementary Material.