Notes

Realtime research study simulations regarding transmission of Pancreas Condition (PD) throughout Norwegian salmonid farming regarding disease management purposes.
rs than does endoscopic decompression for a herniated disc. Most dural tears are small and can be successfully managed with mechanical compression with Gelfoam and sealants. Two-thirds of patients with incidental dural tears had an entirely uneventful postoperative course. The remaining one-third of patients may develop a persistent CSF leak, radiculopathy with dysesthesia, sensory loss, or motor function loss. Patients should be educated preoperatively and reassured.

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A retrospective case-series of revision sacroiliac joint (SIJ) fusions.

To provide a technique guide for revision minimally invasive SIJ fusion.

SIJ dysfunction is a prevalent, yet underdiagnosed condition. This disparity exists as a result of diagnostic complexity and lack of a viable surgical treatment option. However, the advent of minimally invasive SIJ fusion has created a resurgence of interest in this debilitating condition. Multiple studies have reported on the increased use of minimally invasive SIJ fusion in recent years, but there is a paucity of literature on management in a revision setting.

A case series of 5 patients from a single academic tertiary referral center over a 3-year period will serve to highlight technical pearls and considerations in SIJ fusion revision. Revision SIJ fusions were identified through a retrospective review of a surgical database and demographic, surgical, and radiographic data were obtained through review of the electronic medical record.

Five patients underwent SIJ fusion revision from 2015 to 2018. There were 3 main modes of failure, with indications for revision including nerve root irritation and SIJ pain recurrence. The mean age at time of revision was 48.8 ± 14.3 years, and the mean follow-up after revision was 2.0 + 0.9 years. Familiarity with SIJ anatomy and use of stereotactic navigation can improve implant position and purchase. Additionally, bone graft and bone morphogenetic protein can be used to fill in old implant tracks and to augment bony ingrowth and ongrowth of new implants.

Increased use of SIJ fusion creates a demand for comprehensive revision strategies and necessitates familiarity with SIJ anatomy. Preoperative planning to determine causes of failure and use of intraoperative navigation are essential to help surgeons better understand the preferential trajectory for each implant.

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In 2014, inpatient spinal fusion surgery had the highest aggregate cost of any inpatient surgery performed in the United States, costing 12 billion dollars. As the national health care system seeks to improve value-based care, there is increased motivation to perform surgery on an outpatient basis. To ensure improved patient outcomes with this transition, patient selection has become increasingly important to identify who would most benefit from outpatient spine fusion, for example. This demands an improved understanding of the demographics of patients who have been receiving outpatient spine fusion on which the spine surgery community can build to improve cost-effective care delivered.

The Healthcare Cost and Utilization Project, State Ambulatory Surgery Databases, and Agency for Healthcare Research and Quality databases were queried for demographic data regarding all-cause outpatient spine surgery between 2012 and 2014. Outpatient surgery volume was compared with inpatient surgery volume-which was provided by the State Inpatient Databases.

A total of 1,164,040 spine fusion procedures were identified between 2012 and 2014, of which 132,900 procedures were performed as outpatient surgery (11.4%). selleck chemical Of all fusion procedures amongst 18- to 44-year-old patients, 18.4% were outpatient. A larger proportion of white patients, rather than black or Hispanic patients, underwent ambulatory procedures (12.14% vs 9.53% vs 7.46%, respectively); 16.54% of spinal fusion procedures for patients with private insurance was performed on an outpatient basis. Based on patient income, 76% of all outpatient fusions were performed on patients who live in "not low" income ZIP codes.

There has been a gradual trend toward performing more outpatient spinal fusion procedures over the studied period. This study has also revealed unique trends in the demographics of patients who have received outpatient spine fusion during this time.

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Recent literature confirms the importance of understanding the variability in pedicle morphology among races. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, there is limited data on average pedicle diameters (PDs) or estimated pedicle screw lengths (EPSLs) between diverse racial populations. We sought to determine the differences in PD and EPSL in the lumbar spine between various races "Asian," "Black," "White," and "Hispanic" to aid in perioperative planning during instrumented spinal fusion.

Axial cuts of 404 patients were inspected to obtain their transverse outer cortical PD as measured through the isthmus, and EPSL by measuring the posterior entry point at the longest distance, which perpendicularly transected the measured isthmic diameter, to the anterior vertebral cortex from L1 to L5. We examined the average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis.

In this retrospective chart review the races were found to be significantly different in PD and EPSL (
< .001). Post hoc analysis using Dunn-Bonferroni correction showed that Asians had significantly smaller PDs than Blacks and Whites (
< .002 and
< .014, respectively). The White and Hispanic population had significantly longer EPSLs when compared to Blacks and Asians from L1 to L5 (
< .01).

This study demonstrates that there are significant differences in pedicle morphology among races that must be taken into consideration when inserting pedicle screws during lumbar spinal fusion. Knowledge of these differences is of the utmost importance in order to limit complications while improving fixation.

3.

Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.
Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.
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