The spine journal : official journal of the North American Spine Society
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Comparative Study
Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures.
Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. ⋯ Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively.
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Spinal surgery carries risks of incidental spinal cord and nerve root injury. Neuroprotection, to minimize the extent of such injuries, is desirable. However, no neuroprotective strategies have been conclusively validated in nonvascular spinal surgery. Mild hypothermia resulting from general anesthesia is a readily achievable potential neuroprotective strategy. Mild hypothermia, however, has been associated with wound infection, increased operative blood loss and other complications. No previous studies have specifically evaluated whether mild hypothermia is associated with an increased risk of these complications in elective spinal surgery. ⋯ Operative blood loss was not linked to any index of the patient's temperature. Longer anesthesia durations were linked to complications and increased blood loss. Regarding mild hypothermia, neither mean nor nadir hypothermic temperatures were linked to complications, but the estimated total quantity of subbaseline temperature was linked, as was total fluctuation in temperature. Lengthy exposure to mild hypothermia appeared to be associated with wound infections. The use of mild hypothermia as a potential neuroprotective strategy during spinal surgery appears to be reasonably safe, but to avoid complications, the duration of hypothermic exposure should be minimized.
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Pain anticipated before and induced by physical activities has been shown to influence the physical performance of patients with chronic back pain. Limited data exist as to the influence of treatment on this component of pain. ⋯ Anticipated and induced pain with physical activities was lessened after physical therapy using exercise. Anticipated and induced pain with physical activities related to physical performance levels, global pain and disability ratings. These findings may help explain how exercise exerts a positive influence on chronic back pain and disability.
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Comparative Study
Human lumbar facet joint capsule strains: II. Alteration of strains subsequent to anterior interbody fixation.
In cases of low back pain associated with biomechanical lumbar instability, anterior interbody fixation can be used as a surgical treatment, but its affect on facet joint capsule strains is unknown. ⋯ Restriction of a vertebral motion segment using a single ATLP increased adjacent capsular strains, which if suprathreshold for capsule nociceptors, could play a role in low back pain.
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Somatosensory evoked potentials (SSEPs) monitor global spinal cord function, and the interpretation of motor loss is based on inferred rather than direct measurements. Therefore, SSEPs may not be useful for identifying motor function deficits caused by anterior spinal column injury or nerve root injury during decompression or placement of instrumentation. For these reasons, adjunctive methods for monitoring may be especially useful during cervical spine surgery. ⋯ The results illustrate the potential utility of intraoperative SSEPs and the tceMEPs for detection of changes in spinal cord function related to patient positioning and hemodynamic effects during anterior cervical fusion.