The spine journal : official journal of the North American Spine Society
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Ossification of the posterior longitudinal ligament (OPLL) or ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy and is relatively common in the Japanese population and literature. However, no series of OPLL combined with OLF has been previously published. Many different surgical procedures have been used for the treatment of thoracic OPLL or OLF. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical treatment of thoracic OPLL combined with OLF have also not been established. ⋯ Thoracic OPLL combined with OLF is an uncommon cause of myelopathy in the Chinese population. It can present acutely after minor trauma. A considerable degree of neurologic recovery was obtained by posterior decompression with instrumented fusion, despite the anterior impingement of the spinal cord by the remaining OPLL. In addition, the rate of postoperative complications was low with this procedure. We consider that one-stage posterior decompression and instrumented fusion be selected for patients in whom the spinal cord is severely damaged before surgery and/or when circumferential decompression is associated with an increased risk.
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To date, many studies have examined the effects of one or several factors on blood loss during lumbar spine surgery. The nature and extent of the operation, patient position, blood pressure, and a variety of factors related to patient size have been touted as predictors of blood loss. ⋯ This is the first study to build a successful multivariable predictive model of blood loss during spine surgery. The Jackson table was effective in supporting patients with different body sizes and shapes, thus removing raised intra-abdominal pressure as an important factor.
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Signal intensity changes observed in magnetic resonance imaging (MRI) do not reveal the actual severity of axonal damage incurred in spinal cord injuries. Diffusion tensor imaging (DTI) is an imaging technique with a potential to track individual nerve fiber tracts. ⋯ The study shows that DTI tractography is useful for structural imaging of the spinal cord. Fractional anisotrophy, RA, and VR parameters were found to be more sensitive than ADC and E1 values in assessing the severity of compression.
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Neuropathic pain after nerve injuries is characterized by positive and negative sensory symptoms and signs. The extent of sensory fiber loss after nerve injuries has been demonstrated to correlate with symptoms of neuropathic pain by quantitative sensory testing and confirmed by biopsies of small nerve fibers. However, the relationship between the pathologic changes of large nerves on injuries and resulting pain symptoms remains unclear. ⋯ Transient injuries on sensory fibers can produce either positive or negative symptoms of neuropathic pain, and the different extent of sensory fiber loss after different degrees of injuries might account for the varied resulting symptoms of neuropathic pain.
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Comparative Study
Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence.
Lumbar degenerative kyphosis (LDK) is characterized by sagittal imbalance resulting from a loss of lumbar lordosis (LL). The pelvic incidence (PI) regulates the sagittal alignment of the spine and pelvis. ⋯ The results of this study suggest the importance of the key anatomical parameter, PI, in the determination of sagittal contour in symptomatic LDK patients and normal population. Spinopelvic parameters and pelvic compensatory mechanisms in LDK patients differ according to PI. Identifying the spinopelvic parameters is useful when correcting deformities.