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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Recurrent lumbar disc herniation is the most common complication after discectomy. Due to the altered anatomy with the presence of scar tissue, the surgical revision of already operated patients could be a surgical challenge. ⋯ There is no clear guideline for the surgical treatment of recurrent disc herniations. In most cases, a pure re-discectomy is sufficient and can be performed safely and effectively with the help of a microscope. These slides can be retrieved under Electronic Supplementary Material.
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Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. ⋯ Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. These slides can be retrieved under Electronic Supplementary Material.
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Gamma-aminobutyric acid analogues are commonly used to treat neuropathic and chronic pain before and after spinal surgery in recent years. Aim of this study is to investigate the influence of pregabalin on spinal fusion and to determine the proper pregabalin dose for postoperative utilization in a validated rat intertransverse spinal fusion. ⋯ Histological analysis and manual palpation results showed inhibition of spinal fusion formation with high doses of pregabalin. According to these results, administration of high-dose pregabalin should be avoided at the postoperative period until successful fusion is obtained in patients who undergo spinal fusion surgery. These slides can be retrieved under electronic supplementary material.
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The purpose of this study is to compare clinical patient-reported outcomes and radiographic sagittal parameters between obese and non-obese patients following open posterior lumbar spine fusion (PLSF). ⋯ Obese patients had significantly more comorbidities and longer operative time compared to non-obese patients. However, sagittal parameters, patient-reported outcomes, inpatient complications, length of hospital stay, and reoperations were similar between groups. Given these findings, open PLSF can be considered safe and effective in obese patients after thorough consideration of related comorbidities. These slides can be retrieved under Electronic Supplementary Material.
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Related to the development and diffusion of ALIF and XLIF, it is possible to correct sagittal malalignment in selected cases of lumbar degenerative discopathy with a relatively low invasiveness. Still, the malposition or the inappropriate size of the implanted cages may lead to the subsidence of the vertebral endplates with loss of correction as well as a decrease in the potential to restore spinal biomechanics in the long run. The aim of this study is to evaluate safety, feasibility, and preliminary clinical and radiological results when using custom-made, trabecular titanium cages in ALIF and XLIF procedures. ⋯ Custom-made, trabecular titanium cages allowed a segmental, steady, durable sagittal correction via ALIF and XLIF approaches. The absence of cage subsidence at 1 year encourages further studies on a larger cohort with longer follow-up. These slides can be retrieved under Electronic Supplementary Material.