Instructional course lectures
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Lumbar spinal stenosis, which affects an ever-increasing number of patients, is best defined as a collection of clinical symptoms that includes low back pain, bilateral lower extremity pain, paresthesias, and other neurologic deficits that occur concomitantly with anatomic narrowing of the neural pathway through the spine. The narrowing may be centrally located in the spinal canal or more laterally in the lateral recesses or neuroforamina. Lumbar spinal stenosis can have a congenital or acquired etiology, and the origin of acquired lumbar stenosis is classified as degenerative, posttraumatic, or iatrogenic. ⋯ A significant number of patients improve after nonsurgical treatment, although most studies have found that patients treated surgically have better clinical results. Delaying surgical treatment until after a trial of nonsurgical treatment does not affect the outcome. Surgical intervention should be considered only if a comprehensive program of nonsurgical measures fails to improve the patient's quality of life.
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Periprosthetic fracture with preexisting severe loss of bone stock is a challenging condition to treat. Available surgical options can be divided into three categories: complex reconstruction of the deficient proximal femur with secure distal fixation; segmental substitution of the proximal femur with a megaprosthesis or allograft/stem composite; and distally fixed replacement with a modular stem, which acts as a scaffold around which the remaining deficient proximal bone can be assembled, to unite and possibly reconstitute.