The spine journal : official journal of the North American Spine Society
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Patients with spinal tumors are often referred for preoperative angiography and embolization before surgical resection to minimize intraoperative bleeding. ⋯ Preoperative embolization was angiographically effective in most cases. Avid gadolinium enhancement (Grade 3) on MRI was not predictive of hypervascularity on angiography. Furthermore, hypervascularity was not restricted to classically vascular tumors, such as RCC, as it was noted in some patients with breast and prostate cancer. However, with the available numbers, the quality of preoperative embolization did not significantly affect intraoperative blood loss. A future prospective randomized controlled study may be warranted to better characterize the benefits of preoperative embolization for spinal tumors.
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Case Reports
Contralateral psoas seroma after transpsoas lumbar interbody fusion with bone morphogenetic protein-2 implantation.
The lateral transpsoas approach to interbody fusion of the lumbar spine (lateral lumbar interbody fusion [LLIF]) with recombinant human bone morphogenetic protein-2 (BMP-2) augmentation has been increasingly performed in recent years. Potential side effects and adverse sequelae of BMP-2 in the acute setting remain to be fully elucidated. ⋯ A serous psoas muscle fluid accumulation after BMP-2 implantation may rarely occur contralateral to the surgical approach for LLIF. Further characterization of complications related to BMP-2 implantation after lumbar spinal surgery will help guide preoperative informed decision making and the management of this unusual postoperative adverse event.
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Spinal fusion is a common but controversial treatment for chronic low back pain (LBP) with outcomes similar to those of programmed conservative care. To improve the results of fusion, tests for patient selection are used in clinical practice. ⋯ No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.
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The primary goal of surgical arthrodesis is to eliminate the motion of spinal segments in an effort to alleviate pain, improve deformity, and reduce disability. However, decreased spinal mobility may impair performance of activities of daily living (ADLs) due to the resulting stiffness or the lack of mobility of the fused segment. Current clinical outcome instruments do not seek information regarding the impact of spinal stiffness on functional ability. Therefore, a patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities was devised and assessed for internal consistency, retest repeatability, and external validity. ⋯ This pilot study demonstrates that the LSDI questionnaire is a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among spinal arthrodesis patients. The questionnaire is proposed for use in prospective evaluation of lumbar stiffness impacts after arthrodesis.
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Comparative Study
The biomechanics of a multilevel lumbar spine hybrid using nucleus replacement in conjunction with fusion.
Degenerative disc disease is commonly a multilevel pathology with varying deterioration severity. The use of fusion on multiple levels can significantly affect functionality and has been linked to persistent adjacent disc degeneration. A hybrid approach of fusion and nucleus replacement (NR) has been suggested as a solution for mildly degenerated yet painful levels adjacent to fusion. ⋯ These data portend more natural functional outcomes and fewer adjacent disc complications for a multilevel NR+fusion hybrid compared with the classical two-level fusion.