The spine journal : official journal of the North American Spine Society
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The ideal timing of surgical decompression or stabilization following combat-related spine injury remains unclear. ⋯ Our study found that instability or progressive kyphosis and incomplete decompression were the most common indications for reoperation after evacuation to the United States. Our data provide additional understanding of the potential etiologies of failure and reoperation following in-theater combat spine surgery, and may help avoid such complications.
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Hydrogen sulfide (H2S), as a novel gaseous messenger molecule, plays an important role in signal transduction and biological modulation. ⋯ With the above data, we conclude that H2S could reduce the oxidative stress and has neuroprotective effect in acute cauda equina syndrome.
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Intraoperative reduction of low-grade lumbar spondylolisthesis (LGLS) remains disputed. There is currently no published data comparing midterm outcomes of reduction versus in situ fusion. ⋯ Intraoperative reduction does not improve outcomes in LGLS with neurogenic symptoms after MIS TLIF. Adequate decompression and solid fusion are likely the keys to good mid-term outcomes.
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Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit. ⋯ Nonoperative ASD patients who achieved MCID in SRS activity or pain had a lower baseline SRS pain score and less coronal deformity in the TL region. Greater baseline pain offers significant room for potential improvement, which may be important in identifying ASD patients who have the potential to reach MCID nonoperatively. Coronal deformities in the TL region and associated vertebral obliquity may negatively impact potential for improvement in nonoperative care.
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Comparative Study
Clinical utility of ultrasound to prospectively monitor distraction of magnetically controlled growing rods.
Growing rods are commonly used for surgical treatment of skeletally immature patients with scoliosis, but require repeated surgeries for distractions and are fraught with complications. As an alternative, the use of magnetically controlled growing rods (MCGR) allows for more frequent non-invasive distractions to mimic normal growth. However, more plain radiographs are needed to monitor increased distraction frequency, thereby increasing ionizing radiation exposure to the developing child. The use of ultrasound, which emits no radiation, has been found in a cross-sectional study to be reliable in measuring MCGR distractions. ⋯ This is the first prospective study to validate that ultrasound assessment of MCGR distraction lengths was highly comparable with that of plain radiographs. The present study has verified that ultrasound can be used to document length changes by distraction over time and that it had high clinical utility. Ultrasound can be a reliable alternative to plain radiographs, thereby avoiding radiation exposure and its potential detrimental sequelae in the developing child.