The spine journal : official journal of the North American Spine Society
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The published literature has not characterized the surgeon's learning curve with the technically demanding technique of a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). ⋯ The MIS TLIF is a technically difficult procedure to the practicing spine surgeon with regard to intra- and perioperative parameters of surgical time, estimated blood loss, intravenous fluid, and duration of anesthesia. Operative time and proficiency improved with understanding the minimally invasive technique. Further studies are warranted to delineate the methods to minimize the complications associated with the learning curve.
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Abnormal somatosensory evoked potential (SEP) (ie, prolonged latency) has been associated with poor surgical prognosis of cervical spondylotic myelopathy (CSM). ⋯ Spinal tracts were not uniformly affected in the myelopathic cervical cord. Changes in diffusion indices could delineate focal or extensive myelopathic lesions in CSM, which could account for abnormal SEP. DTI analysis of spinal tracts might provide additional information not available from conventional diagnostic tools for prognosis of CSM.
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In spinal surgery, newly developed technology seems to play a key role, especially with the use of computer-assisted image-guided navigation, giving excellent results. However, these tools are expensive and may not be affordable for many facilities. ⋯ In conclusion, the authors of the study are of the opinion that the surgical procedure of pedicle screw fixation, using a CT-based computer-guidance system with support of the O-Arm system, allows a shortening of procedure time that might improve the clinical result. However, the present study failed to determine a clear cost-effectiveness with respect to other CT-based IGS.
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Randomized Controlled Trial
Intraoperative systemic infusion of lidocaine reduces postoperative pain after lumbar surgery: a double-blinded, randomized, placebo-controlled clinical trial.
Analgesic effect of lidocaine infusion on postoperative pain. ⋯ Intraoperative systemic infusion of lidocaine decreases pain perception during microdiscectomy, thus reducing the consumption of opioid and the severity of postoperative pain. This effect contributes to reduce the length of HS.