The spine journal : official journal of the North American Spine Society
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The impact of patient factors and medical comorbidities on the risk of mortality and complications after spinal arthrodesis has not been well described. Prior works have been limited by small sample size, single center data, or the inability to be broadly generalized. ⋯ Several factors, including patients' age, BMI, ASA classification more than 2, pulmonary conditions, procedural times, and nutritional status likely influence the risk of postoperative morbidity to varying degrees. The risk factors identified here may be more generalizable to the American population as a whole because of the design and methodology of the NSQIP in comparison with previously published studies.
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Lateral interbody fusion (LIF) is a minimally invasive procedure that is designed to achieve a solid interbody fusion while minimizing the damage to the surrounding soft tissue. Although short-term results have been promising, few data have been published to date regarding its risks and complication rate. ⋯ Hip flexion was weakened immediately after the LIF procedure, which may be attributed to psoas muscle injury during the procedure. However, this damage was temporary, with almost complete return to baseline values by 2 weeks.
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Randomized Controlled Trial
Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?
Surgical reduction and posterior lumbar interbody fusion (PLIF) is commonly used to recover segmental imbalance in degenerative spondylolisthesis. However, whether intentional reduction of the slipped vertebra during PLIF is essential in aged patients with degenerative spondylolisthesis remains controversial. ⋯ Posterior lumbar interbody fusion with pedicle screws fixation, with or without intraoperative reduction, provides good outcomes in the surgical treatment of aged patients with degenerative spondylolisthesis. Better radiological outcomes by intentional reduction do not necessarily indicate better clinical outcomes.
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Acquired hyperpneumatization of the skull base and upper cervical vertebrae is extremely rare and is thought to occur in patients who habitually perform the Valsalva maneuver or engage in repetitive positive pressure activities such as scuba diving or free diving. Craniocervical hyperpneumatization has been reported to cause intracranial and extracranial pneumatoceles but is not generally considered as a cause of pneumorrhachis (air in the spinal canal). Pneumorrhachis is relatively rare, and usually occurs in a localized form, either in the cervical spine secondary to skull base fractures or in the thoracic spine secondary to pneumomediastinum or pneumothorax. Here, we report a case of extensive pneumorrhachis extending from the skull base to the thoracolumbar junction in association with marked axio-atlanto-occipital hyperpneumatization and pneumomediastinum. This unique constellation of findings likely resulted from complications of the Valsalva maneuver during strenuous exercise. ⋯ Craniocervical hyperpneumatization is a rare complication of the Valsalva maneuver. Most reported cases have involved only the skull base, or the skull base and C1, and many have been further complicated by microfractures leading to pneumocephalus or extracranial pneumatoceles. We present a unique case of extensive craniocervical hyperpneumatization that extended to the level of C2 and was complicated by microfractures causing severe pneumorrhachis. Concurrent pneumomediastinum in this case may have been an independent complication of the Valsalva maneuver, which could have contributed to pneumorrhachis. Alternatively, pneumomediastinum may have been caused by migration of gas through the neural foramen from the epidural space, driven by positive pressure generated by the one-way valve effect of the Eustachian tube during periods of exertion.
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The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. ⋯ Published reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.