The spine journal : official journal of the North American Spine Society
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Ambulation limitation is the hallmark of impairment in lumbar spinal stenosis (LSS). Capacity and performance have been defined as two distinct aspects of disability. Previous literature suggests that a person's walking capacity may not be reflected in their daily walking performance. ⋯ Walking capacity and walking performance in LSS appear to be different constructs. Survey instruments appear to reflect capacity rather than performance. This dissociation between walking capacity and walking performance has implications for the clinical management and outcomes assessment of people with LSS.
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Surgical indications for lumbar burst fracture remain controversial. Potential indications for surgery include 50% canal compromise, 50% loss of vertebral height, 30° of kyphosis, and posterior element fracture or disruption of the posterior ligamentous complex. Different surgical approaches are available depending on fracture characteristics. It is possible that a minimally invasive approach could allow for a safe and effective treatment with fewer comorbidities than the traditional open technique. ⋯ The traditional approach to an anterior lumbar corpectomy and posterior pedicle screw fixation involves significant postoperative pain and frequent ileus. This minimally invasive approach allowed for early mobilization, resumption of diet, and discharge from the hospital on postoperative day two.
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Patients with thoracic tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts. ⋯ The authors think that the one-stage anterior autogenous rib grafts and instrumentation are safe and effective methods in the surgical management of thoracic tuberculosis.
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Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. We describe a severe complication associated with this procedure; only one previous case has been reported in the literature. ⋯ Although percutaneous vertebroplasty has many benefits, including its simplicity and relative safety, it could lead to serious complications. The current case demonstrates the direct leakage of cement within the anterior spinal artery leading to an irreversible paralysis. The clinicians should be aware of such complications to happen and explain it to their patients.
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Randomized Controlled Trial
No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises.
Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. ⋯ Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up.