The spine journal : official journal of the North American Spine Society
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Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK. ⋯ The SRS-Schwab Grade 4 osteotomy, if selected appropriately, could provide satisfying correction of congenital kyphosis. The correction could be well maintained during the longitudinal follow-up.
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Observational Study
The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result.
Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS. ⋯ Patients with preoperative high HGS display better surgical outcome in terms of disability and health status 6 months after spine surgery. Preoperative HGS can act as a predictor of surgical outcome in patients with DLSS.
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Observational Study
Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion.
Revision posterior decompression and fusion surgery for patients with symptomatic adjacent segment degeneration (ASD) is associated with significant morbidity and is technically challenging. The use of a stand-alone lateral lumbar interbody fusion (LLIF) in patients with symptomatic ASD may prevent many of the complications associated with revision posterior surgery. ⋯ Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with symptomatic ASD following a previous lumbar fusion.
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As health-care transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and postoperative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. ⋯ Preoperative opioid use among patients who underwent cervical fusion increases complication rates, postoperative opioid usage, health-care resource use, and costs. These risks may be reduced by restricting the duration of preoperative opioid use or weaning off before surgery. Better understanding and management of pain in the preoperative period with judicious use of opioids is critical to enhance outcomes after cervical fusion surgery.
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Comparative Study
Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion.
Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited. ⋯ This study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements postoperatively compared with TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of postoperative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery.