The spine journal : official journal of the North American Spine Society
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Understanding patient expectations is a critical component of patient-centered care; however, little is known about which expectation(s) are most important to patients as they relate to their sense of postoperative success. ⋯ Our findings highlight the need to identify and address specific individual expectations as part of the shared decision-making and presurgery education process.
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Review Meta Analysis
Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary.
There are three phases in prophylaxis of surgical site infections (SSI): preoperative, intraoperative and postoperative. There is lack of consensus and paucity of evidence with SSI prophylaxis in the postoperative period. ⋯ Despite the postoperative period being key in SSI prophylaxis, the literature is sparse and without consensus on optimum postoperative care for SSI prevention in spine surgery. The current best evidence is presented with its limitations. High quality studies addressing high risk cohorts such as the elderly, obese, and diabetic populations, and for traumatic and oncological indications are urgently required.
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Predicting postoperative prognosis with preoperative diagnostic imaging has clinical importance. Recent studies have indicated the utility of diffusion tensor imaging (DTI) to quantify the severity of cervical spondylotic myelopathy (CSM) and assess the prognosis of surgical outcomes. However, how to apply DTI to evaluate CSM in a clinical setting is not fully elucidated. Neurite orientation dispersion and density imaging (NODDI) is a model-based practical diffusion-weighted magnetic resonance imaging analysis for estimating specific microstructural features related directly to neuronal morphology. In a prior study, we indicated preoperative NODDI parameters are a promising tool with which to predict neuronal recovery after decompression surgery in patients with CSM with 2 years follow-up. However, the correlation between NODDI parameters and postoperative long-term outcomes and change of parameters over time postoperatively has remained largely unknown. ⋯ NODDI is a reproducible and reliable method for evaluation of CSM. ICVF improved after surgery and recovery of physical findings accompanied this change. ICVF may be applied clinically to predict postoperative recovery.
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Radiologic evidence of successful lumbar fusion has traditionally been based on bridging bone spanning the intertransverse processes (posterolateral fusion or PLF) or disc space (interbody fusion, or IBF). Often, postoperative computed tomography (CT) of unsuccessful PLF and IBF demonstrates bridging bone across the facet joints or connecting the medial transverse process to the ipsilateral superior articular facet of the caudal vertebra. The significance of this finding in terms of implant stability and clinical outcomes has not previously been reported. ⋯ FJF/PMF is often observed on postoperative CT evaluation following surgery originally performed to achieve PLF or IBF. Short-term follow-up suggests no significant difference in implant loosening rates or patient reported outcomes when FJF/PMF is observed versus PLF or IBF in such patients. Long-term clinical outcomes of FJF/PMF versus PLF or IBF remain unknown. These findings apply solely to single-level instrumented spinal fusion surgery utilizing pedicle screws with or without IBF.
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Lumbar herniated nucleus pulposus (HNP) is a common spinal pathology often treated by microscopic lumbar discectomy (MLD), though prior reports have not demonstrated which preoperative MRI factors may contribute to significant clinical improvement after MLD. ⋯ Patients who met MCID after MLD had larger HNP areas and larger Hemi-HNP Areas than those who did not meet MCID. These patients were also 2.7× more likely to have a gray MRI signal than a mixed or black MRI signal. When accounting for HNP area relative to canal area, patients who met MCID had greater Hemi-HNP canal occupation than patients who did not meet MCID. The results of this study suggest that preoperative MRI parameters can be useful in predicting patient-reported improvement after MLD.