The spine journal : official journal of the North American Spine Society
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Clinical Trial
Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture.
Most atlas fractures can be effectively treated nonoperatively with external immobilization unless there is an injury to the transverse atlantal ligament. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1-C2 or C0-C2, but these treatments usually result in loss of the normal motion of the C1-C2 and C0-C1 joints. ⋯ An open reduction and posterior internal fixation with atlas polyaxial lateral mass screw-plate is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique can provide immediate reduction and preserve C1-C2 motion.
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Despite an increase in the clinical use of no-profile anchored interbody cages (AIC) for anterior cervical discectomy and fusion (ACDF) procedures, there is little published biomechanical data describing its stabilizing effect relative to the traditional anterior plating technique over two contiguous levels. ⋯ The anchored cage fusion construct conferred similar acute biomechanical stability in lateral bending and axial rotation ROMs relative to rigid anterior plating. We identified a statistically significant reduction (Δ=3.4°, combined over two levels) in sagittal plane ROM conferred by the ALP relative to the AIC construct. Our biomechanical findings may support the clinical use of no-profile integrated interbody devices over two contiguous levels in ACDF.
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Thoracolumbar extension-distraction fractures are rare injuries mainly restricted to patients suffering from ankylosing spinal disorders. The most appropriate surgical treatment of these unstable spinal injuries remains to be clarified. ⋯ In fragile patients with ankylosing spinal disorders and thoracolumbar extension-distraction fractures, closed reduction and percutaneous dorsal instrumentation provide a satisfying midterm functional outcome while minimizing perioperative risks compared with conventional dorsoventral procedures.
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Although the high cost of spine surgery is generally recognized, there is little information on the extent to which payments vary across hospitals. ⋯ Medicare payments for episodes of spine surgery vary widely across hospitals. As they respond to the new financial incentives inherent in health care reform, high cost hospitals should focus on the use of spinal fusion and postacute care.
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Comparative Study
Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma.
The decision for operative treatment of patients with spinal metastases is dependent on the patient's predicted survival. Tokuhashi, Tomita, Bauer, and Oswestry scores have been devised for survival prediction; however, none of these systems have been evaluated in nasopharyngeal carcinoma (NPC). ⋯ Patients with spinal metastases from NPC have relatively good survival prognosis. All four scoring systems could be used to prognosticate these patients. The modified Tokuhashi score is the best in doing so.