Articles: surgery.
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We present our experience in the management of symptomatic vertebral hemangiomas with epidural extension (SVHEE) using spine stereotactic radiosurgery (SSRS). ⋯ To our knowledge, this represents the largest series of SVHEE patients treated with SSRS, either as monotherapy or part of a multimodal/separation surgery treatment approach. We demonstrate that SSRS represents a potentially safe and effective treatment option in these patients. However, larger prospective studies and longer follow-ups are necessary to further assess the role, durability, and toxicity of SSRS in the management of these patients.
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Although opioids are a mainstay for perioperative pain management in hip fracture patients, no studies have described changes in opioid use over the last two decades. The aim of this study was to describe time trends in opioid use in a population-based cohort of patients undergoing a first-time hip fracture surgery during 1997-2018. ⋯ Overall, opioid use in Q1 after hip fracture surgery increased 2.7 times from 1997 to 2018, but the doses and opioid use up to 1 year after surgery remained stable. Compared to elderly, younger patients were more likely to use opioid in Q1, while the tendency was opposite in Q2-Q4. The most used opioid type changed from tramadol to oxycodone. Our findings underline the importance of personalized opioid tapering and doses, and use of opioids with the lowest potential for addiction and other adverse events.
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In this study we aimed to identify whether paraspinal muscle morphology could play a role in surgical decision-making in patients with lumbar spondylolisthesis. ⋯ Each 1-point increment in fatty infiltration in the erector spinae at any lumbar level increased the likelihood of surgery by 8%. Lumbar spondylolisthesis patients with fatty infiltration score for erector spinae at or above 17 were more likely to have surgery. We recommend clinicians to focus on improving erector spinae muscles in patients with lumbar spondylolisthesis.