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1.
Eur Spine J ; 25(1): 230-234, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26363560

ABSTRACT

PURPOSE: The state of adjacent level discs and its impact on surgical outcomes following single-level lumbar discectomy have not been previously investigated. The purpose of the present study was to determine if a significant relationship exists between the degree of preoperative adjacent level disc degeneration and post-operative clinical outcomes following lumbar discectomy. METHODS: This study retrospectively used preoperative magnetic resonance imaging (MRI) and prospectively collected data from a randomized clinical trial at two tertiary-care academic hospitals. Patients who underwent a primary, single-level lumbar discectomy were included. Exclusion criteria included prior lumbar surgery. Outcome measures were the Modified Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) scores for back and leg pain. These were recorded at baseline and at 3 months, 1, and 2 years postoperatively. An independent reviewer graded adjacent level disc degeneration on all preoperative MRIs using the Pfirrmann grading scale. These data were then analyzed for correlation with each outcome measure. RESULTS: Forty-seven patients were included in the study. No statistically significant correlations were found when comparing preoperative 3-month or 1-year postoperative scores or change from baseline of any outcome measure between Pfirrmann grades. Only about half the patients had 2-year follow-up, but at that time point a statistically significant difference in back VAS scores was observed between Pfirrmann groups. No other significant differences were observed at that point. CONCLUSIONS: The degree of preoperative adjacent level degeneration does not significantly affect functional or pain relief outcomes following lumbar discectomy up to 1 year after surgery.


Subject(s)
Diskectomy , Intervertebral Disc Degeneration/diagnosis , Lumbar Vertebrae/surgery , Magnetic Resonance Imaging , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Intervertebral Disc Degeneration/surgery , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
2.
Global Spine J ; 5(4): 308-14, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26225280

ABSTRACT

Study Design Retrospective cohort study. Objective To determine the short-term outcomes of two different lateral approaches to the lumbar spine. Methods This was a retrospective review performed with four fellowship-trained spine surgeons from a single institution. Two different approach techniques were identified. (1) Traditional transpsoas (TP) approach: dissection was performed through the psoas performed using neuromonitored sequential dilation. (2) Direct visualization (DV) approach: retractors are placed superficial to the psoas followed by directly visualized dissection through psoas. Outcome measures included radiographic fusion and adverse event (AE) rate. Results In all, 120 patients were identified, 79 women and 41 men. Average age was 64.2 years (22 to 86). When looking at all medical and surgical AEs, 31 patients (25.8%) had one or more AEs; 22 patients (18.3%) had a total of 24 neurologically related AEs; 15 patients (12.5%) had anterior/lateral thigh dysesthesias; 6 patients (5.0%) had radiculopathic pain; and 3 patients (2.5%) had postoperative weakness. Specifically, for neurologic AEs, the DV group had a rate of 28.0% and the TP group had a rate of 14.2% (p < 0.18). When looking at the rate of neurologic AEs in patients undergoing single-level fusions only, the DV group rate was 28.6% versus 10.2% for the TP group (p < 0.03). Conclusion Overall, 18.3% of patients sustained a postoperative neurologic AE following lateral interbody fusions. The TP approach had a statistically lower rate of neurologic-specific AE for single-level fusions.

4.
J Hand Surg Am ; 37(1): 63-7, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22051228

ABSTRACT

Lunate fractures are rare and are usually associated with high-energy trauma. Typically, they are described in isolation or with associated carpal injuries such as scaphoid, capitate, or radial styloid fractures. We report a case of a complex lunate fracture in combination with a perilunate dissociation injury.


Subject(s)
Delayed Diagnosis , Fractures, Bone/surgery , Lunate Bone/injuries , Lunate Bone/surgery , Wrist Injuries/surgery , Accidents, Traffic , Bone Screws , Fracture Fixation, Internal/methods , Fracture Healing/physiology , Fractures, Bone/diagnostic imaging , Humans , Injury Severity Score , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Lunate Bone/diagnostic imaging , Male , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/surgery , Radiography , Rare Diseases , Trauma Centers , Treatment Outcome , Wrist Injuries/diagnostic imaging
5.
Clin Orthop Relat Res ; 470(6): 1621-32, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21948287

ABSTRACT

BACKGROUND: The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary. QUESTIONS/PURPOSES: We identified the incidence of complications associated with the lateral transpsoas approach to the lumbar spine. PATIENTS AND METHODS: We retrospectively reviewed 45 patients who underwent a lateral transpsoas approach to the spine for various diagnoses between January 1, 2006, and October 31, 2010. The patients' average age was 63.3 years. Sixteen (35.6%) patients had prior lumbar spinal surgery. Twenty-one patients (46.7%) underwent supplemental posterior instrumentation. Minimum followup was 0 months (mean, 11 months; range, 0-34 months). RESULTS: Eighteen of the 45 patients (40%) had complications: 10 (22.2%) developed postoperative iliopsoas weakness, three had quadriceps weakness, and one experienced foot drop. Eight patients (17.8%) developed anterior thigh hypoesthesia, which did not fully resolve in seven of the eight patients at an average of 9 months' followup. Three patients had postoperative radiculopathies, one a durotomy, and one died postoperatively from a pulmonary embolism. CONCLUSIONS: We found a 40% incidence of complications and a nontrivial frequency and severity of postoperative weakness, numbness, and radicular pain in patients who underwent a lateral transpsoas approach to the spine. Given the expanding use of the approach, a thorough understanding of the risks associated with it is essential for patient education, medical decision making, and identifying methods of reducing such complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Subject(s)
Lumbar Vertebrae/surgery , Spinal Fusion/adverse effects , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Psoas Muscles/surgery , Spinal Fusion/methods
6.
J Pediatr Orthop B ; 17(5): 257-60, 2008 Sep.
Article in English | MEDLINE | ID: mdl-19471179

ABSTRACT

Measurement of capillary refill time (CRT) is thought of as a fast and inexpensive tool for assessing perfusion to an extremity or digit. CRT is frequently relied upon by orthopedic surgeons, especially in the postoperative period when pulses may be inaccessible owing to casts or dressings. Yet to our knowledge, no study has attempted to correlate CRT with other indices of perfusion to the extremity. We evaluated the association between CRT and arterial flow in pediatric upper extremities. Our hypothesis was that arterial flow would be inversely proportional to CRT--that decreased perfusion would be associated with prolonged CRT. Ten children between the ages of 8 and 17 years with no systemic or upper extremity abnormalities were studied. Radial and ulnar artery flows were evaluated with Doppler ultrasound. Measurements of the radial and ulnar flow volumes were summed, to approximate total flow to the extremity. CRT was measured to the tenth of a second with the use of digital video. Three sets of the above measurements were taken for each participant--at baseline and at two levels of decreased perfusion (produced by inflating a blood pressure cuff to 25 and 75 mmHg). Linear regression was used to analyze the data. A lack of correlation was found between arterial flow and CRT (r=0.02, P=0.93). Though the study has its weaknesses, the results caution the use of CRT as a solitary measure of perfusion in children. This was a level 1 diagnostic study.


Subject(s)
Blood Flow Velocity/physiology , Capillaries/physiology , Microcirculation/physiology , Upper Extremity/blood supply , Adolescent , Capillary Resistance , Child , Female , Humans , Linear Models , Male , Radial Artery/diagnostic imaging , Radial Artery/physiology , Reference Values , Regional Blood Flow , Sampling Studies , Sensitivity and Specificity , Time Factors , Ulnar Artery/diagnostic imaging , Ulnar Artery/physiology , Ultrasonography, Doppler , Upper Extremity/diagnostic imaging
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