http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Jeffery Head,George Rymarczuk,Geoffrey Stricsek,Lohit Velagapudi,Christopher Maulucci,Christian Hoelscher,James Harrop 대한척추신경외과학회 2019 Neurospine Vol.16 No.3
Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). Decompressive surgery is the standard of care for OPLL and can be achieved through anterior, posterior, or combined approaches to the cervical spine. Surgical correction of OPLL via any approach is associated with higher rates of complications and the presence of OPLL is considered a significant risk factor for perioperative complications in DCM surgeries. Potential complications include dural tear (DT) and subsequent cerebrospinal fluid leak, C5 palsy, hematoma, hardware failure, surgical site infections, and other neurological deficits. Anterior approaches are technically more demanding and associated with higher rates of DT but offer greater access to ventral OPLL pathology. Posterior approaches are associated with lower rates of complications but may allow for continued disease progression. Therefore, the decision to pursue either an anterior or posterior approach to surgical decompression may be critically influenced by complications associated with each procedure. The authors critically review anterior and posterior approaches to surgical decompression of OPLL with particular focus on the complications associated with each approach. We also review the recent work in developing new surgical treatments for OPLL that aim to reduce complication incidence.
Are Lumbar Fusion Guidelines Followed? A Survey of North American Spine Surgeons
Thiago S. Montenegro,Christopher Elia,Kevin Hines,Zorica Buser,Jefferson Wilson,Zoher Ghogawala,Shekar N. Kurpad,Daniel M. Sciubba,James S. Harrop 대한척추신경외과학회 2021 Neurospine Vol.18 No.2
Objective: To evaluate the use of guidelines for lumbar spine fusions among spine surgeons in North America. Methods: An anonymous survey was electronically sent to all AO Spine North America members. Survey respondents were asked to indicate their opinion surrounding the suitability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accordance with North America Spine Society (NASS) guidelines for lumbar fusion were considered NASS-concordant answers. Respondents were considered to have a NASS-concordant approach if ≥70% (13 of 18) of their answers were NASS-concordant answers. Comparisons were performed using bivariable statistics. Results: A total of 105 responses were entered with complete data available on 70. Sixty percent of the respondents (n=42) were considered compliant with NASS guidelines. NASS-discordant responses did not differ between surgeons who stated that they include the NASS guidelines in their decision-making algorithm (5.10±1.96) and those that did not (4.68± 2.09) (p=0.395). The greatest number of NASS-discordant answers in the United States. was in the South (5.75±2.09), with the lowest number in the Northeast (3.84±1.70) (p< 0.01). For 5 survey items, rates of NASS-discordant answers were ≥40%, with the greatest number of NASS-discordant responses observed in relation to indications for fusion in spinal deformity (80%). Spine surgeons utilizing a NASS-concordant approach had a significant lower number of NASS-discordant answers for synovial cysts (p=0.03), axial low back pain (p<0.01), adjacent level disease (p<0.01), recurrent stenosis (p<0.01), recurrent disc herniation (p=0.01), and foraminal stenosis (p<0.01). Conclusion: This study serves an important role in clarifying the rates of uptake of clinical practice guidelines in spine surgery as well as to identify barriers to their implementation.