A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.

Study Design: A prospective and randomized study.

Objectives: The objective of this study was to assess the efficacy of a novel multimodal analgesic regimen in reducing postoperative pain and intravenous morphine requirements after primary multilevel lumbar decompression surgery.

Summary Of Background Data: The use of opioid medications after surgery can lead to incomplete analgesia and may cause undesired side effects such as respiratory depression, somnolence, urinary retention, and nausea.

Lumbar decompression and fusion in a centenarian.

The incidence of chronic and debilitating conditions in the aging population is steadily increasing, and the treatment of extreme elderly patients with spinal conditions can be challenging. Spinal stenosis and spondylolisthesis can dramatically affect patient quality of life, and patients commonly seek a surgical solution for their condition. Many extreme elderly patients are cautioned against surgery secondary due to their high complication and in-hospital mortality rates when compared with younger patients.

Cement augmentation of refractory osteoporotic vertebral compression fractures: survivorship analysis.

Study Design: Retrospective cohort.

Objective: To compare survivorship after cement augmentation of refractory osteoporotic vertebral compression fractures (OVCFs) with traditional inpatient pain management and bracing.

Summary Of Background Data: OVCFs can cause debilitating pain and functional decline necessitating prolonged bed rest and high-dose narcotics.

Detection of postoperative neurologic deficits using somatosensory-evoked potentials alone during posterior cervical laminoplasty.

Background Context: The use of neurophysiologic monitoring during anterior and posterior cervical decompression procedures in patients with spondylotic myelopathy remains controversial. The ideal neurophysiologic monitoring modality of choice is also highly debated.

Purpose: The purpose of this study was to evaluate the utility of neurophysiologic monitoring with only somatosensory-evoked potentials (SSEPs) in a consecutive series of laminoplasty procedures with regard to the detection of new postoperative neurologic deficits.

Risk of progression in de novo low-magnitude degenerative lumbar curves: natural history and literature review.

Natural history studies have focused on risk for progression in lumbar curves of more than 30 degrees, while smaller curves have little data for guiding treatment. We studied curve progression in de novo degenerative scoliotic curves of no more than 30 degrees. Radiographs of 24 patients (17 women, 7 men; mean age, 68.

Steroids and risk factors for airway compromise in multilevel cervical corpectomy patients: a prospective, randomized, double-blind study.

Study Design: Prospective, randomized, double-blind study.

Objective: To evaluate intravenous corticosteroids in preventing delayed extubation after multilevel corpectomy and strut graft reconstructive procedures and to identify risk factors for delayed extubation in these patients.

Summary Of Background Data: We performed a prospective, randomized double-blind study in patients undergoing multilevel cervical corpectomy procedures.

Adjacent level ossification development after anterior cervical fusion without plate fixation.

Study Design: A retrospective.

Objective: The proximity of the plate to the adjacent disc space appeared to be the critical determinant of adjacent level ossification development (ALOD) but we had no data on unplated arthrodesis. Without such data, we could not be positive that ALOD was a complication related to plates.

Degenerative spondylolisthesis of the cervical spine: analysis of 58 patients treated with anterior cervical decompression and fusion.

Background Context: Degenerative spondylolisthesis has been well described as a disorder of the lumbar spine. Few authors have suggested that a similar disorder occurs in the cervical spine. To our knowledge, the present study represents the largest series of patients with long-term follow-up who were managed surgically for the treatment of degenerative spondylolisthesis of the cervical spine.

Dropped head deformity due to cervical myopathy: surgical treatment outcomes and complications spanning twenty years.

Study Design: Case series.

Objective: Report long-term outcomes, complications, and surgical technique of cervical myopathy (CM) patients treated with posterior instrumented, cervico-thoracic (C-T) fusions.

Summary Of Background Data: CM is a rare, progressive, debilitating condition where weakness of neck extensor muscles results in a dropped head deformity (DHD), or severe flexible, cervico-thoracic kyphosis.

Preoperative narcotic use as a predictor of clinical outcome: results following anterior cervical arthrodesis.

Study Design: Prognostic Study, Level II (Retrospective review of prospectively collected data).

Objective: To identify an association between preoperative narcotic use and clinical outcome after cervical arthrodesis.

Summary Of Background Data: Little data exists regarding the influence that chronic preoperative narcotic use has on clinical outcomes after surgery.

Myelographic evaluation of cervical spondylosis: patient tolerance and complications.

Study Design: Retrospective chart review of documented adverse events in 637 consecutive patients after computed tomogram myelography and follow-up interview of the most recent 100 of these patients.

Objectives: This study assessed documented prevalence of adverse events after diagnostic myelography in cervical spondylotic patients and compared with perceived adverse events and satisfaction in a subset of the same cohort of patients.

Summary Of Background Data: There are some data that suggest complimentary benefits of myelography to magnetic resonance imaging.

Reherniation and failure after lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy.

Study Design: Retrospective review of 259 lumbar discectomies.

Objective: To compare rates of reoperation after subtotal discectomy versus established rates after fragment excision.

Summary Of Background Data: Herniated nucleus pulposes (HNP) and annular morphology influence rates of reherniation after discectomy.

Ketorolac use for postoperative pain management following lumbar decompression surgery: a prospective, randomized, double-blinded, placebo-controlled trial.

Study Design: Prospective randomized double-blind placebo-controlled study.

Objective: The objective of this study was to assess the efficacy of Ketorolac in reducing postoperative pain and morphine requirements following primary multilevel lumbar decompression surgery.

Summary Of Background Data: The use of opioid medications following surgical interventions can be complicated by related side effects such as respiratory depression, somnolence, urinary retention, and delayed time to oral intake.

Weight loss in overweight and obese patients following successful lumbar decompression.

Background: Neurogenic claudication secondary to lumbar stenosis is often cited by overweight and obese patients as a factor limiting their ability to lose weight. Many patients believe that they will be able to increase their activity and subsequently lose weight following relief of symptoms. The objective of this study was to evaluate weight loss in overweight and obese patients who obtained substantial pain relief after lumbar decompression surgery for spinal stenosis.

Failure within one year following subtotal lumbar discectomy.

Background: Reherniation within the first year following subtotal lumbar discectomy is a rare but noteworthy event. We performed a retrospective, case-controlled study to evaluate the clinical outcomes after early recurrent lumbar disc reherniation.

Methods: The records of 1320 patients who had undergone primary subtotal lumbar discectomy were analyzed retrospectively by an independent reviewer.

Risk for infection after anterior cervical fusion: prevention with iodophor-impregnated incision drapes.

Cervical spine infections can have disastrous consequences, but techniques for minimizing infections should be evidence based. In this article, we report the incidence of spine infections in a large cohort of consecutive patients who underwent anterior cervical fusions without iodophor-impregnated incision drapes (3M Ioban; 3M Health Care, St. Paul, Minn) covering the surgical site.

Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients.

Study Design: Retrospective review.

Objective: To quantify and describe perioperative complication rates in a large series of well-matched elderly patients who underwent lumbar decompression and arthrodesis.

Summary Of Background Data: Posterior lumbar decompression and fusion is frequently performed to treat lumbar stenosis with instability.

Surgical treatment of destructive calcific lesions of the cervical spine in scleroderma: case series and review of the literature.

Study Design: An independent retrospective chart review combined with a review of current literature.

Objectives: To describe a series of destructive, calcific masses of the cervical spine causing pain, neurologic dysfunction, and instability in patients with scleroderma and detail the surgical interventions required. To review benign, calcific cervical spine lesions associated with scleroderma and collagen vascular disorders.

Changes in the iliac crest-lumbar relationship from standing to prone.

Background Context: It is known that positioning patients on the Jackson and Andrews operative tables causes changes in lumbar lordosis and pelvic rotation. However, it is unknown if the relationship between the iliac crest and underlying lumbar levels, in particular the L4-L5 interspace, changes from standing to prone on these tables.

Purpose: To assess the changes in the relationship between the iliac crests and lumbar spinal levels from standing to prone on two different operative positions using the Jackson and Andrews frames.

Use of spinous processes to determine drill trajectory during placement of lateral mass screws: a cadaveric analysis.

Objective: Prior cadaveric research showed that the lateral mass and facets are landmarks to determine the initial starting point for lateral mass screws and that the optimum screw trajectory was 30 degrees lateral and 15 degrees cephalad. The missing link was an intraoperative landmark to guide the trajectory for drilling according to these angles. The authors hypothesized that spinous processes can be used to guide the trajectory for lateral mass screw placement.

Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis.

Background: Chin-on-chest deformity is a disabling manifestation of ankylosing spondylitis. Surgical treatment consists of extension osteotomy at the cervicothoracic junction. The purpose of this study was to characterize the clinical presentation of this deformity and to determine the long-term functional and radiographic outcomes of treatment.

Degenerative disorders of the lumbar and cervical spine.

Degenerative disorders in the spine are normal, age-related phenomena and largely asymptomatic in most cases. Conservative management of lumbar and cervical spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately with nonsurgical management. Surgical intervention can be considered an appropriate and viable option when conservative measures have failed.

Spinal exostoses: analysis of twelve cases and review of the literature.

Study Design: Retrospective review of spinal exostoses treated at our institution and literature review.

Objectives: Review of 12 cases of spinal exostoses treated at our institution compared with 165 cases of spinal exostoses reported in the literature.

Summary Of Background Data: Spinal exostoses are uncommon.