Evid Based Spine Care J
· 2010 May · PMID 23544022
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STUDY DESIGN: Prospective cohort study. CLINICAL QUESTION: Does the patients' body mass index (BMI) influence the degree of intraoperative lumbar lordosis in patients undergoing operative treatment on the Mizuho Orthop...STUDY DESIGN: Prospective cohort study. CLINICAL QUESTION: Does the patients' body mass index (BMI) influence the degree of intraoperative lumbar lordosis in patients undergoing operative treatment on the Mizuho Orthopedic Systems Incorporated (OSI) Jackson spinal table? METHODS: Twenty-four consecutive patients undergoing posterior spinal instrumentation and fusion on the Jackson table, excluding those with sagittal malalignment, underwent standing preoperative and prone intraoperative lateral x-rays. Intervertebral body angle measurements were obtained from L1-S1 using the modified method of Cobb. Changes in angle measurements were compared to BMI using linear regression and ANOVA. RESULTS: We found a mean lordosis of 52.6° in standing preoperative x-rays compared to a prone position mean lordosis of 61.5° on the Jackson table. The mean change was 8.88° with a range of 0°-18°. A linear association between lordosis and BMI was demonstrated (P < .0022). As BMI increased, so did lordosis (correlation coefficient, 0.59). CONCLUSIONS: The current study is the first in which a correlation of patient body mass and use of the Jackson table has been evaluated. These data suggest that BMI influences lumbar lordosis on the Jackson table and that care must be used when dealing with a population with large BMI on the Jackson table. [Table: see text] The definiton of the different classes of evidence is available on page 83.
Barbanti Bròdano G, Lolli F, Martikos K
… +5 more, Gasbarrini A, Bandiera S, Greggi T, Parisini P, Boriani S
Evid Based Spine Care J
· 2010 May · PMID 23544021
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STUDY DESIGN: Retrospective cohort study. CLINICAL QUESTION: Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar inte...STUDY DESIGN: Retrospective cohort study. CLINICAL QUESTION: Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar interbody fusion (PLIF) than those who receive posterolateral fusion (PLF)? METHODS: One hundred and fourteen patients affected by adult low grade isthmic spondylolisthesis, treated with posterior lumbar interbody fusion or posterolateral fusion, were reviewed. Clinical outcome was assessed by means of the questionnaires ODI, RMDQ and VAS. Radiographic evaluation included CT, MRI, and x-rays. The results were analyzed using the Student t-test. RESULTS: The two groups were similar with respect to demographic and surgical characteristics. At an average follow-up of 62.1 months, 71 patients were completely reviewed. Mean ODI, RMDQ and VAS scores didn't show statistically significant differences. Fusion rate was similar between the two groups (97% in PLIF group, 95% in PLF group). Major complications occurred in 5 of 71 patients reviewed (7%): one in the PLIF group (3.6%), four in the PLF group (9.3%). Pseudarthrosis occurred in one case in the PLIF group (3,6%) and in two cases in PLF group (4.6%). CONCLUSIONS: In our series, there does not appear to be a clear advantage of posterior lumbar interbody fusion (PLIF) over posterolateral fusion (PLF) in terms of clinical and radiological outcome for treatment of adult low grade isthmic spondylolisthesis.
Bransford RJ, Zhang F, Bellabarba C
… +1 more, Lee MJ
Evid Based Spine Care J
· 2010 May · PMID 23544020
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STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if there is a difference in outcome and complications in surgically managed patients with thoracic-disc herniations (TDH) undergoing a modified transfac...STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if there is a difference in outcome and complications in surgically managed patients with thoracic-disc herniations (TDH) undergoing a modified transfacet pedicle-sparing decompression and fusion (posteriorly) compared to those undergoing anterior transthoracic discectomies (anteriorly). METHODS: Thirty-five consecutive operatively managed TDH underwent operative management between March 2003 and November 2009. Outcomes and complications were reviewed from patient records and x-rays assessing differences between those treated posteriorly and those treated anteriorly. RESULTS: Twenty-four patients underwent posterior management for 35 TDH and ten patients underwent anterior management for twelve TDH. Mean age was 50 years in both groups. Body mass index (BMI) averaged 28.8 in the anterior group and 32.0 in the posterior group. Follow-up averaged 38 weeks with four patients lost to follow-up (all posterior). Major complications secondary to surgery occurred in three patients (30%) in the anterior group (pulmonary embolus, pneumonia, and wrong level surgery) and in seven patients (35%) in the posterior group (seroma, misplaced instrumentation requiring revision, recurrence requiring an additional operation, and four infections). No neurological complications occurred and all patients noted improvement from baseline. Average length of stay was 7.3 days in the anterior group and 4.2 days in the posterior group (P < .003). Final pain as assessed by visual analog scale (VAS) improved from 6.7 to 4.3 in the anterior group and 6.9 to 2.3 in the posterior group (P = .05). CONCLUSIONS: Complication rates are similar between groups and are approach related. Posteriorly managed patients had greater improvement in pain and shorter length of stay. [Table: see text] The definition of the different classes of evidence is available on page 83.
Barbagallo GM, Corbino LA, Olindo G
… +1 more, Albanese V
Evid Based Spine Care J
· 2010 May · PMID 23544019
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STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To analyze the presence and clinical relevance of heterotopic ossification (HO) at 3 years mean follow-up. METHODS: Thirty patients suffering from cervical radiculo...STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To analyze the presence and clinical relevance of heterotopic ossification (HO) at 3 years mean follow-up. METHODS: Thirty patients suffering from cervical radiculopathy and/or myelopathy treated with anterior disc replacement (ADR) were studied. HO was classified using the McAfee grading system. Range of motion was measured from flexion and extension x-rays. Short-form 36 and neck disability index (NDI) assessed functional outcome. RESULTS: Forty-five prostheses were implanted in 30 patients with cervical radiculopathy and/or myelopathy, mean age 40.9 years. Nineteen patients received 1 level and 11 patients received multilevel disc replacement. The incidence rate of HO was 42.2% (19 levels). Segmental range of motion was ≥3° in 93.8% of patients with HO. There was no significant difference in functional scores between those who did and those who did not develop HO. Males tended to develop HO more frequently than females, though this was not statistically significant. The indication for surgery (soft disc hernia or spondylosis) was not associated with the formation of HO. CONCLUSIONS: Functional improvement is maintained despite the presence of HO following cervical disc arthroplasty. Indications for arthroplasty should not be halted by the risk of HO. [Table: see text] The definiton of the different classes of evidence is available on page 83.
Evid Based Spine Care J
· 2010 May · PMID 23544018
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So what is a "winning literature search"? Simply put, it is one that provides you with the information you need to find the types of articles that will help you with clinical practice or research. Literature searching is...So what is a "winning literature search"? Simply put, it is one that provides you with the information you need to find the types of articles that will help you with clinical practice or research. Literature searching is a combination of an art and a science. Understanding the basic anatomy and physiology of searching can get you started on finding the information you need.