World Neurosurg
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To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. ⋯ Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
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Conventional surgical treatment of multilevel cervical disc disease is based on anterior cervical discectomy and fusion (ACDF). However, fusion alters the biomechanics of the spine, potentially resulting in accelerated adjacent segment degeneration. To improve clinical outcomes, hybrid surgery, combining cervical disc arthroplasty with fusion, has been developed. Cervical total disc replacement (TDR) has been shown to keep the motion of adjacent segment, and a dynamic cervical implant (DCI) was shown to provide cervical dynamic stability under nonfusion. However, curative and unwanted side effects of the new therapy options TDR and DCI for treating multilevel cervical degenerative disc disease are still unknown. ⋯ These results indicate that both TDR hybrid and DCI hybrid are effective and safe procedures for the treatment of multilevel degenerative disc disease. However, there is no definitive evidence that DCI or TDR arthroplasty lead to better intermediate-term results than ACDF over an average observation time of 19.5 months.
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Surgery should be considered for patients with metastatic epidural spinal cord compression (MESCC) with a life expectancy of ≥3 months. Given the heterogeneity of the clinical presentation and outcomes, clinical prognostic models (CPMs) can assist in tailoring a personalized medicine approach to optimize surgical decision-making. We aimed to develop and internally validate the first CPM of health-related quality of life (HRQoL) and a novel CPM to predict the survival of patients with MESCC treated surgically. ⋯ The calibration for both CPMs was very good. We developed and internally validated the first CPMs of survival and HRQoL at 3 months postoperatively in patients with MESCC using the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) guidelines. A web-based calculator is available (available at: http://spine-met.com) to assist with clinical decision-making.
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Major complications after spine metastasis surgery are prioritized in the literature with little consideration of the more frequent minor events such as pneumonia or urinary tract infection. We analyzed incidence and risk factors of postsurgical complications in patients with spinal metastasis extracted from the National Surgical Quality Improvement Program (NSQIP). We also developed a useful predictive model to estimate the probability of occurrence of complications. ⋯ Smoking status and emergent surgery were found to be the strongest independent predictors of major complications, whereas higher American Society of Anesthesiologists class showed a greater association with minor events. The predictive models produced can be a useful aid for surgeons to identify those patients who are at greater risk of developing postoperative adverse events.
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To compare the clinical outcome between bilateral percutaneous endoscopic debridement and lavage (PEDL) and unilateral PEDL treatment for lumbar spine tuberculosis (LST). ⋯ Two procedures yielded comparable and satisfactory results. Unilateral PEDL showed shorter operative time and decreased intraoperative fluoroscopy times compared with bilateral PEDL. We suggest the use of unilateral PEDL rather than bilateral PEDL in the treatment of LST.