The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
Postdural puncture headache: impact of needle type, a randomized trial.
The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. ⋯ We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.
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Comparative Study Controlled Clinical Trial
Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis: posterior lumbar interbody fusion may be better than posterolateral fusion.
More and more orthopedic surgeons recognize the importance of the sagittal balance of the spine. ⋯ Either PLF or PLIF would lead a great change in spinopelvic parameters and deformity parameters. The decrease of PT may be an important role for the short-term surgical outcome. The PLIF could increase the LL and form a more reasonable sagittal alignment. From the point of the sagittal spinopelvic balance, the PLIF may be better than the PLF for patients with isthmic spondylolisthesis.
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Previous studies have reported position-dependent changes of the lumbar intervertebral foramen (LIVF) dimensions at different static flexion-extension postures. However, the changes of the LIVF dimensions during dynamic body motion have not been reported. ⋯ Human lumbar foramen dimensions show segment-dependent characteristics during the dynamic weight-lifting activity.
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Proteus syndrome (PS) is an extremely rare congenital disorder causing asymmetric overgrowth of different tissues. The etiology remains unclear. Limb deformities are common and often necessitate amputations. Only a few cases associated with spinal deformities have been described. ⋯ Proteus syndrome can be associated with spinal stenosis and deformity. Although the syndrome can be progressive in nature, the symptomatic spinal pathology should be treated appropriately.
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Transverse connectors (TCs) are often used to improve the rigidity of posterior spinal instrumentation as previous investigations have suggested that TCs enhance torsional rigidity in long-segment thoracic constructs. Posterior osteotomies, such as pedicle subtraction osteotomy (PSO), are used in severe thoracic deformities and provide a significant amount of correction; as a consequence, however, PSOs also induce three-column spinal instability. In theory, augmentation of longitudinal constructs with TC after a thoracic PSO may provide additional rigidity, but the concept has not been previously evaluated. ⋯ Two TCs significantly improved torsional rigidity of the entire construct and at the PSO site, with no differences in rigidity for FE and LB or with the addition of only one TC. In the setting of a PSO and long-segment pedicle screw-rod construct, augmentation with at least two TCs should be considered to improve torsional rigidity.