The spine journal : official journal of the North American Spine Society
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The lumbar multifidus muscle provides an important contribution to lumbar spine stability, and the restoration of lumbar multifidus function is a frequent goal of rehabilitation. Currently, there are no reliable and valid physical examination procedures available to assess lumbar multifidus function among patients with low back pain. ⋯ Our results provide preliminary evidence supporting the reliability and validity of the MLT to assess lumbar multifidus function at the L4-L5 spinal level. Additional research examining the measurement properties and utility of this test should be undertaken before confident implementation with patients.
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The relation between specific types of lumbosacral transitional vertebra and the degree of degeneration at and adjacent to the transitional level is unclear. It is also unknown whether the adjacent cephalad segment to a transitional vertebra is prone to greater degeneration than a normal L5-S1 level. ⋯ Increasing the mechanical connection of a lumbosacral transitional vertebra protects the disc at the transitional level and predisposes the adjacent cephalad segment to greater degeneration. The adjacent cephalad segment had a comparable degree of degeneration as the L5-S1 level in control subjects.
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Elective posterior lumbar fusion is a common surgical procedure, but reported length of hospital stay is variable (usually 3-7 days). The effect of a limited number of factors on length of stay (LOS) has previously been evaluated. However, multivariate analysis using LOS as a dependent variable to separate potentially confounding variables has not been performed. ⋯ Patients who are older and have widespread systemic disease tend to stay in the hospital longer after surgery. Contrary to our expectations, no single comorbidity was predictive of longer hospital stays. Heart disease was associated with a shorter LOS, but this may have been due to a more extensive preoperative workup and closer medical management. Intraoperative events did not affect LOS; however, postoperative events did. These data should prove useful for counseling patients and setting expectations of patients and the health care team.
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The true incidence of symptomatic spinal epidural hematoma (SEH) after surgery of the posterior cervical spine and risk factors for its development remain unclear. ⋯ Symptomatic SEH may occur in up to 1.5% of patients undergoing posterior cervical spine surgery. Patients with a higher level of comorbid disease appear to be at increased risk of development of a symptomatic SEH, although avoidance of postoperative NSAIDs may decrease the risk of its development.
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Instrumentation failure is a recognized complication after complex spinal reconstruction and deformity correction. Rod fracture (RF) is the most frequent mode of hardware failure in long-segment spinal fusion surgery. This complication can negatively impact the clinical outcome by producing spinal pain, functional compromise, instability, and loss of deformity correction. ⋯ The risk of rod failure is substantial in the setting of long-segment spinal arthrodesis and corrective osteotomy. Efforts to increase the mechanical strength of posterior constructs may reduce the occurrence of this complication. The outrigger rod technique increases spinal construct stiffness and may improve the longevity of the construct. This technique should reduce the rate of device failure during maturation of posterior fusion mass and limit the need for supplemental anterior column support.