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(Download PDF) 50 Landmark Papers Every Spine Surgeon Should Know Alexander R Vaccaro Online Ebook All Chapter PDF
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every
Spine Surgeon Should Know
every
Spine Surgeon
Should Know
EDITORS
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Contributors xv
introduCtion xxi
v
vi Contents
index 253
Contributors
Reviewers
xv
xvi Contributors
Study Design The SOSG first conducted two preliminary systematic reviews
to identify clinical and radiographic factors associated with overt or impending
instability involving tumors of the cervical and thoracolumbar spine. A
modified Delphi technique was used to integrate the available evidence with
expert opinion to develop the classification system. A questionnaire was then
administered to the members of the SOSG that collected factors, based on
individual clinical experience and review of evidence from the literature that
contributed to spinal instability. A preliminary Spine Instability Neoplastic
Score (SINS) was created based on the relative ranking of a particular factor’s
contribution to spinal instability. A second round of questionnaires involved
more critical evaluation of instability factors, in an effort to improve reliability
among evaluators and to improve validity of the score to predict instability in
case examples. The SOSG ultimately defined tumor-related spinal instability
as “loss of spinal integrity as a result of a neoplastic process that is associated
with movement-related pain, symptomatic or progressive deformity, and/or
neural compromise under physical loads.”4 Factors mentioned in the SINS
included regional location of tumor, presence of mechanical/postural pain,
bone lesion quality, spinal alignment, extent of vertebral body involvement/
collapse, and posterolateral involvement of the spinal elements.4,5
Sample Size Not applicable. Three representative cases are presented in the text.
However, the total series of clinical cases reviewed by the SOSG is not reported.
Results The final SINS classification system includes six components, with
a weighted value for each component. As such, the clinical presentation
and imaging findings can be combined to determine an objective status of
instability for a given patient with a neoplastic lesion of the spine. The score
for each component is additive to achieve a final SINS. In terms of location-
specific factors, junctional areas (occiput-C2, C7-T2, T11-L1, and L5-S1) are at
the most risk for developing tumor-related spinal instability, with an assigned
score of 3; the mobile spine (C3-C6, and L2-L4) is assigned a score of 2; the
semirigid spine (T3-T10) is assigned a score of 1, and the rigid sacrum (S2-S5)
is assigned a score of 0. With regard to clinical pain presentation, mechanical
or postural pain is scored based on pain that may be relieved with recumbency
(score of 3), while occasional, nonmechanical pain is assigned a score of 1,
and a pain-free lesions score of 0. The quality of the bone lesion is scored
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Puhemies Näppisen kysyttyä, oliko vielä muita asioita, huusi Kaisa
Kompura kahvilan puolelta, että entäs se vallankumouksen
toimeenpaneminen, jokos siitä on päätetty?
Pekka Suova sanoi, että jos tässä sortaminen olisi kyseessä, niin
olisi hän ensin mennyt tuonne kahvilan puolelle pyytämään
maistellakseen sitä Reeta Sinkkosen limonaatia, jolla on niin muikea
haju, että tuntuu pihalle asti.
8 §.
Kokouksen jatkuessa sääntöperäisessä järjestyksessä ilmoitti
puhemies Näppinen kysymystä olleen kommuunin keskuudessa
yksityisesti, olisiko kommunistien ryhdyttävä keskustelemaan
noskelaisten kanssa yhteistoiminnan aikaansaamisesta
eduskuntavaaleissa köyhälistön rintaman lujittamiseksi porvarillista
taantumusta vastaan.
Paavo Pellikka veti esiin näytöksiä sos. dem. lehdistä, että nämä
tuomitsevat ankarasti porvarillisen oikeuspuntarin, jos se tahtoo
takseerata tuomiota vallankumouksen valmistamisesta, mihin
sihteeri Mikko Tarjus liitti välihuudahduksen, että ne ovat vain
salataantumuksen grogotiilin mustia murhekyyneliä
vallankumouksellisen käsityksen hämäämiseksi.
11 §.
12 §.