The spine journal : official journal of the North American Spine Society
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Few studies have analyzed the results of an interspinous distraction device in patients with lumbar spinal stenosis. It is still unknown whether the outcomes of an interspinous implant are related to the severity of stenosis. ⋯ The Aperius interspinous implant is poorly indicated for severe lumbar stenosis, which is significantly improved only in a small minority of cases, whereas decompression procedures ensure high chances of good results. The implant may be indicated for selected patients with moderate stenosis. The outcomes of the Aperius are not influenced by the type of clinical presentation of lumbar stenosis.
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In obese patients, placing pedicle screws percutaneously is a particular challenge. As the bulky and thick configuration of obese patients may produce fuzzier fluoroscopic view and longer passage of surgical instruments, the chances of misplacement might increase. ⋯ Although symptomatic pedicle violations were noted in the earlier period of surgeon's learning curve and in overweight and obese patients, no statistical evidence could be found between patient's body habitus and percutaneous pedicle screw misplacement. Our data also suggest that greater caution should be exercised to avoid pedicle violations especially at L3 and L4.
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Research on lumbosacral transitional vertebra (LSTV) has yielded important information on the structural alterations of the sacrum associated with LSTV. Nevertheless, very little data are available on the relationship of a given type of LSTV with either a typical pattern of sacral morphology or its gender distribution in the population. ⋯ Different lumbosacral transitions share a stronger, definite, and specific patterns of relationship with certain sacral morphologies and gender. It is important to recognize the nuances of these connections so as to understand low back pain conditions in the setting of a typical sacral articular morphology or the sex of the individual.
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Spinal fusion is a commonly performed surgical procedure. It is used to treat a variety of spinal pathologies, including degenerative disease, trauma, spondylolisthesis, and deformities. A mechanically stable spine provides an ideal environment for the formation of a fusion mass. Instrumented spinal fusion allows early ambulation with minimal need for a postoperative external immobilizer. Several biomechanical and clinical studies have evaluated the stability offered by different posterior instrumentation techniques and the effects of reduced instrumentation. ⋯ The V construct exhibited enhanced stability compared with UPS construct in all loading modes. It provides bilateral fixation and preserves the anatomic integrity of the superior facet joint. The novel construct may offer advantages of less invasiveness, significant reduction in operation time, duration of hospitalization, and costs of implants, which would require further clinical evaluation.
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For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle for recovery from acute, subacute, and chronic low back pain. ⋯ By incorporating an understanding of FAB, clinicians may enhance their ability to assess the predicaments of their patients with low back pain and gain insight into potential value of corrective information that lessen fears and concerns on well-being of their patients.