The spine journal : official journal of the North American Spine Society
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Primary malignant tumors of the sacrum are rare. Chondrosarcoma is one of the common malignant tumors arising from the sacrum. Chondrosarcoma is often invasive, and there is a high propensity for local recurrence. Surgical resection is often the only effective treatment; however, the treatment of malignant sacral tumors can be challenging, both because of the anatomy of the spinopelvic complex and the frequently large tumor size. ⋯ The advantages of our method include the availability of high dose of radiation because of extracorporeal irradiation, excellent fit between graft and host bone, reduction of the dead space, no immunological rejection, no need for a bone bank, availability of the sacrum not only for the augmentation of the large defect but also for the scaffold for the other bone grafts. Our report is of only one case; however, we consider that it could be one option for the treatment of sacral malignant bone tumors, such as chondrosarcoma.
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Despite the frequency with which surgeons perform posterior spinal surgery and the precautions against wrong-site surgery, operations on incorrect levels still occur. Wrong-level exposure is documented in 0.32% to 15% of cases. Additionally, there is little consensus as to what is the most accurate method for localizing the correct spinal level. ⋯ Despite the variety of localization modalities, most surgeons use only a few. Whereas wrong-level localization is relatively rare, the ideal frequency is never. There is no standard approach that will entirely eliminate these mistakes; however, using a localization time out and increasing awareness of common sources of error may help decrease the incidence of wrong-level spine surgery.
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Thoracic myelopathy caused by an anterior, massive ossified plaque is often progressive and responds poorly to conservative treatment. Direct removal of the compressing ossification is the optimal procedure for a spinal cord that is severely impinged anteriorly. However, both anterior and posterior decompressive manipulations have caused catastrophic iatrogenic spinal cord injuries. A comprehensive treatment method for severe thoracic myelopathy that enables a sufficient and safe decompression of the spinal cord is needed. ⋯ One-stage posterior decompression, anterior extirpation of the ossification, and interbody fusion with instrumentation via a modified posterior approach is a safe and effective treatment for severe thoracic myelopathy resulting from prominent anterior impingement. This procedure is technically demanding, and the indications are limited to thoracic myelopathy caused by severe anterior impingement of various etiologies from T4-T12.
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Randomized Controlled Trial
Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.
Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. ⋯ The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors.