Articles: spinal-fusion-adverse-effects.
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Randomized Controlled Trial Comparative Study
Protective effects of preserving the posterior complex on the development of adjacent-segment degeneration after lumbar fusion: clinical article.
During the past decades, lumbar fusion has increasingly become a standard treatment for degenerative spinal disorders. However, it has also been associated with an increased incidence of adjacent-segment degeneration (ASD). Previous studies have reported less ASD in anterior fusion surgeries; thus, the authors hypothesized that the integrity of the posterior complex plays an important role in ASD. This study was designed to investigate the effect of the posterior complex on adjacent instability after lumbar instrumentation and the development of ASD. ⋯ During follow-up for 6 years, a significantly higher number of patients with ASD were noted in the complete-laminectomy group. The number of reoperations for treating ASD was much higher in this patient group than in the patients undergoing facet joint resection and L4-5 fusion or semilaminectomy and fusion. Therefore, preserving the posterior complex as much as possible during surgery plays an important role in preventing ASD and in reducing the reoperation rate.
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Randomized Controlled Trial Comparative Study
Dysphagia after anterior cervical discectomy and fusion: a prospective study comparing two anterior surgical approaches.
The Smith-Robinson approach is commonly used to expose the vertebrae in anterior cervical discectomy and fusion (ACDF). Postoperative dysphagia has been frequently reported following this procedure. In this approach, surgical dissection can be carried out either lateral (LEO) or medial (MEO) to the omohyoid muscle. The purpose of this study was to compare the degree of dysphagia between the LEO and MEO groups. ⋯ The findings from this study suggest that the LEO approach should be selected if the level of surgery involves C3-C4. For C6-C7 surgery, however, a left-sided MEO approach should be used. Depending on surgeon's preference, either approach can be used if both cervical levels are involved.
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Randomized Controlled Trial
Retrograde ejaculation following single-level anterior lumbar surgery with or without recombinant human bone morphogenetic protein-2 in 5 randomized controlled trials: clinical article.
The aim of this study was to determine the incidence and assess specific risk factors in the postoperative development of retrograde ejaculation (RE) in men treated for degenerative lumbar disc disease at the L4-5 or L5-S1 level with stand-alone anterior interbody implants with or without recombinant human bone morphogenetic protein-2 (rhBMP-2). ⋯ In these 5 prospective randomized trials involving anterior lumbar interbody surgery, the use of rhBMP-2 was associated with a higher incidence of RE (3.4% vs 1.7%) but did not reach statistical significance. Based on surgical approach, the difference in rates of RE was statistically significant. This study reports on the outcomes of 5 prospective randomized FDA-approved investigational device exemption trials. Registration for studies became law in 2007. Four of these trials were completed before the law went into effect. The registration number for the lumbar disc arthroplasty trial is NCT00635843.
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Randomized Controlled Trial Multicenter Study
Risk factors associated with ischemic optic neuropathy after spinal fusion surgery.
Perioperative visual loss, a rare but dreaded complication of spinal fusion surgery, is most commonly caused by ischemic optic neuropathy (ION). The authors sought to determine risk factors for ION in this setting. ⋯ This is the first study to assess ION risk factors in a large, multicenter case-control fashion with detailed perioperative data. Obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration were significantly and independently associated with ION after spinal fusion surgery.
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Anesthesia and analgesia · Jan 2011
Randomized Controlled Trial Comparative StudyIntraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery.
Patients undergoing complex spine surgery frequently experience severe pain in the postoperative period. The combined opiate receptor agonist/N-methyl-d-aspartate receptor antagonist methadone may be an optimal drug for these patients given the probable involvement of N-methyl-d-aspartate systems in the mechanism of opioid tolerance and hyperalgesia. ⋯ Perioperative treatment with a single bolus of methadone improves postoperative pain control for patients undergoing complex spine surgery.