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1.  Conservative management of psoas haematoma following complex lumbar surgery 
Indian Journal of Orthopaedics  2014;48(1):107-110.
We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period.
doi:10.4103/0019-5413.125534
PMCID: PMC3931141  PMID: 24600073
Posterior lumbar interbody fusion; postoperative radicular pain; psoas hematoma
2.  Effect of Psychological Status on Outcome of Posterior Lumbar Interbody Fusion Surgery 
Asian Spine Journal  2012;6(3):178-182.
Study Design
Prospective longitudinal study.
Purpose
To determine if preoperative psychological status affects outcome in spinal surgery.
Overview of Literature
Low back pain is known to have a psychosomatic component. Increased bodily awareness (somatization) and depressive symptoms are two factors that may affect outcome. It is possible to measure these components using questionnaires.
Methods
Patients who underwent posterior interbody fusion (PLIF) surgery were assessed preoperatively and at follow-up using a self-administered questionnaire. The visual analogue scale (VAS) for back and leg pain severity and the Oswestry Disability Index (ODI) were used as outcome measures. The psychological status of patients was classified into one of four groups using the Distress and Risk Assessment Method (DRAM); normal, at-risk, depressed somatic and distressed depressive.
Results
Preoperative DRAM scores showed 14 had no psychological disturbance (normal), 39 were at-risk, 11 distressed somatic, and 10 distressed depressive. There was no significant difference between the 4 groups in the mean preoperative ODI (analysis of variance, p = 0.426). There was a statistically and clinically significant improvement in the ODI after surgery for all but distressed somatic patients (9.8; range, -5.2 to 24.8; p = 0.177). VAS scores for all groups apart from the distressed somatic showed a statistically and clinically significant improvement. Our results show that preoperative psychological state affects outcome in PLIF surgery.
Conclusions
Patients who were classified as distressed somatic preoperatively had a less favorable outcome compared to other groups. This group of patients may benefit from formal psychological assessment before undergoing PLIF surgery.
doi:10.4184/asj.2012.6.3.178
PMCID: PMC3429608  PMID: 22977697
Spine; Low back pain; Outcomes research; Spinal fusion; Psychological tests
3.  Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation 
European Spine Journal  2009;21(Suppl 5):653-662.
Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. In this study, authors examined various clinically relevant parameters using a finite element model of C3–C7 cervical spine to study the effects of variations of ball and socket disc designs. Four variations of ball and socket-type artificial disc were placed at the C5–C6 level in an experimentally validated finite element model. Biomechanical effects of the shape (oval vs. spherical ball) and location (inferior vs. superior ball) were studied in detail. Range of motion, facet loading, implant stresses and capsule ligament strains were computed to investigate the influence of disc designs on resulting biomechanics. Motions at the implant level tended to increase following disc replacement. No major kinematic differences were observed among the disc designs tested. However, implant stresses were substantially higher in the spherical designs when compared to the oval designs. For both spherical and oval designs, the facet loads were lower for the designs with an inferior ball component. The capsule ligament strains were lower for the oval design with an inferior ball component. Overall, the oval design with an inferior ball component, produced motion, facet loads, implant stresses and capsule ligament strains closest to the intact spine, which may be key to long-term implant survival.
doi:10.1007/s00586-009-1211-6
PMCID: PMC3377801  PMID: 19936805
Cervical; Disc replacement; Finite element; Biomechanics; Design variation
4.  Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques 
European Spine Journal  2008;17(6):845-852.
We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.
doi:10.1007/s00586-008-0648-3
PMCID: PMC2519000  PMID: 18389294
Bone grafting; Donor site; Morbidity; Trephine; Cervical fusion

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