The spine journal : official journal of the North American Spine Society
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Bupivacaine is a local anesthetic commonly used to relieve or control pain in interventional spine procedures. Bupivacaine has been shown to be toxic to articular cartilage, which has similarities to intervertebral disc (IVD) cartilage, raising concern over a potentially negative effect of bupivacaine on the disc. ⋯ Despite its pain relieving properties, bupivacaine decreases cell viability in rabbit and human disc cells in a time-dependent manner. In addition, the changes observed are greater than that seen for articular chondrocytes. This increase in cell death appears to be related to an increase in necrosis rather than apoptosis. Whether bupivacaine exerts similar effects in vivo or how this relates to overall clinical outcome remains to be explored.
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Restrictive transfusion criteria have led to decreased morbidity and mortality in critically ill patients. Their use has been extended to other patient groups. In adult spine surgery, ongoing postoperative blood losses and soft-tissue trauma may make these patients not appropriate for restrictive transfusion practices. ⋯ Patients with high blood loss (more than 2 L) during spine surgery who are under-resuscitated (HGB level less than 8 g/dL) have a significant increased risk of SSI.
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Transverse sacral fracture in pediatric patients is extremely uncommon with only nine cases reported in literature so far. ⋯ This case is presented to highlight the rarity of a pediatric transverse sacral fracture, which requires a high index of suspicion as early decompression helps in reversing the neurological deficit.
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During the past 25 years, spinal instrumentation systems and surgical techniques used to treat idiopathic scoliosis have evolved, achieving fewer patient restrictions during arthrodesis healing, shorter constructs, and better correction. The purposes of this retrospective comparative study were to determine the survivorship of the implant/fusion without reoperation and the risk factors influencing such survival. ⋯ The most stable lower instrumented vertebra anchor configuration, bilateral pedicle screws, and the stronger transverse connector design, closed drop entry, provided the best survival of the implant/fusion without reoperation with this system and the techniques used at 9-year follow-up. We hope that this post-market study using survivorship techniques will be a guide for studies of other spinal implants.
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Low back pain (LBP) is a prevalent and costly musculoskeletal disorder that often occurs in the working-age population. Although numerous physical activities have been implicated in its complex etiology, determining causation remains challenging and requires a methodologically rigorous approach. ⋯ There was strong evidence from six high-quality studies that there was no association between awkward postures and LBP. Similarly, there was strong evidence from three high-quality studies that there was no temporal relationship. Moreover, subgroup analyses identified only a handful of studies that demonstrated only weak associations and no evidence for other aspects of causality in certain specific subcategories. It is therefore unlikely that awkward occupational postures are independently causative of LBP in the populations of workers studied.