The spine journal : official journal of the North American Spine Society
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Pedicle screw malposition rates using conventional techniques have been reported to occur with a frequency of 6% to 41%. The upper thoracic spine (T1-T3) is a challenging area for pedicle screw placement secondary to the small size of the pedicles, the inability to visualize this area with lateral fluoroscopy, and significant consequences for malpositioned screws. We describe our experience placing 150 pedicle screws in the T1-T3 levels using three-dimensional (3D) image guidance. ⋯ Upper thoracic pedicle screw placement is technically demanding as a result of variable pedicle anatomy and difficulty with two-dimensional visualization. This study demonstrates the accuracy and reliability of 3D image guidance when placing pedicle screws in this region. Advantages of this technology in our practice include safe and accurate placement of spinal instrumentation with little to no radiation exposure to the surgeon and operating room staff.
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Report the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI). ⋯ The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID.
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Case Reports
Neurogenic claudication and radiculopathy as delayed presentations of retained spinal bullet.
Firearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones. ⋯ These cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.