The spine journal : official journal of the North American Spine Society
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Anterior cervical discectomy and fusion (ACDF) using autogenous iliac bone graft may lead to donor-site morbidity. This has led some surgeons to use alternatives to iliac bone graft, but often the alternatives have greater rates of nonunion and delayed union. Bone morphogenic protein (BMP) studies have found high arthrodesis rates in lumbar fusions. ⋯ ACDF performed with BMP (0.9 mg BMP per level) allograft is as effective as iliac bone graft in terms of patient outcomes and fusion rates. Safety concerns related to neck swelling and higher initial costs were associated with patients in the bone morphogenic protein group.
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Randomized Controlled Trial
The perioperative cost of Infuse bone graft in posterolateral lumbar spine fusion.
There is mounting evidence supporting the efficacy of bone morphogenetic protein (BMP) for both anterior interbody and posterolateral lumbar fusion. However, the relative cost of BMP remains an important concern for physicians, hospitals, and payers. ⋯ The hospital carries the cost burden associated with the utilization of rhBMP-2/ACS. In contrast, the payer in a Diagnosis-Related Group (DRG) model achieves a net savings, based primarily on the decreased payment for inpatient rehabilitation, but also on decreased hospital reimbursement, physician costs, and other outpatient services.
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Multicenter Study
Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis.
The publication of several recent studies showing minimal benefit for radiofrequency (RF) lumbar zygapophysial (l-z) joint denervation have led many investigators to reevaluate selection criteria. One controversial explanation for these findings is that the most commonly used cutoff value for selecting patients for l-z (facet) joint RF denervation, greater than 50% pain relief after diagnostic blocks, is too low and hence responsible for the high failure rate. ⋯ Using more stringent pain relief criteria when selecting patients for l-z joint RF denervation is unlikely to improve success rates, and may lead to misdiagnosis and withholding a potentially valuable treatment from good candidates.
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Spontaneous spinal epidural hematoma (SSEH) is a very rare condition, so there were few studies assessing the management criteria of SSEH. ⋯ Precise diagnosis without delay and rapid surgical treatment are essential for the management of SSEH.
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Case Reports
Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review.
Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before. ⋯ Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.