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Subash Lohani, Richard L. Robertson, and Mark R. Proctor

pain due to hemorrhage of an arachnoid cyst not associated with a known trauma. The cyst hemorrhage resulted in subdural hematoma within the brain, and redistribution of blood along the spinal subdural space, hence the unusual presentation with severe back pain. Case Report History and Presentation An 11-year-old boy presented to the orthopedic clinic with a weeklong history of severe back pain radiating into the posterior aspect of his buttocks and thighs. He had no history of trauma. He had no other complaints, and his bowel and bladder function were

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Charles H. Crawford III, Steven D. Glassman, Praveen V. Mummaneni, John J. Knightly, and Anthony L. Asher

S urgical treatment of lumbar stenosis is well supported by current medical evidence. 1 , 10–12 , 16 , 19 , 21 Controversy exists regarding the role of supplemental stabilization or fusion in the absence of gross instability or deformity. 3 , 6 , 15 , 17–18 , 20 Previous authors have noted the conventional theory that patients with significant back pain symptoms may not be adequately improved with decompression-only surgery. 3 , 15 Surgeons may use this theory to justify a fusion or other stabilization procedure, in addition to decompression of

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Bryan Kunkler, Alan Tung, Parag G. Patil, Srinivas Chiravuri, and Vijay Tarnal

neurostimulator). 1 For surgical positioning, patients are placed in a stereotactic headframe and positioned semisupine for the hours-long procedure. 1 With up to 60% prevalence of back pain, 2 patients with Parkinson’s disease may not tolerate the discomfort of the long duration of immobility. 1 In this study, we describe the use of continuous spinal anesthesia (CSA) with a local anesthetic to manage a patient with Parkinson’s disease who had severe back pain and neurogenic claudication and was unable to tolerate DBS placement in a semisupine position. Illustrative

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Rachid Bech-Azeddine, Søren Fruensgaard, Mikkel Andersen, and Leah Y. Carreon

claudication or radicular pain, but low-back pain is also a common complaint. In the presence of predominant back pain, some authors recommend a concomitant fusion to alleviate the back pain. 5 , 6 However, performing a supplemental fusion procedure involves increased blood loss, operative duration, hospital stay, complication rate, and overall surgical cost. 7 , 8 Recent studies have suggested an acceptable improvement of back pain with decompression only in patients with LSS. 9–11 The aim of the present study was to clarify the clinical impact of decompression alone in

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Scott L. Parker, Risheng Xu, Matthew J. McGirt, Timothy F. Witham, Donlin M. Long, and Ali Bydon

T he notion of a herniated disc fragment causing neural compression in the lumbar spinal canal was first reported by Mixter and Barr in 1934. 15 Today, lumbar discectomy is the most commonly performed spinal procedure in the US, with ~ 300,000 cases each year. 2 , 7 Multiple studies have revealed that lumbar discectomy improves pain, physical function, and disability in the majority of patients; 12 , 16 , 19–21 however, 10–30% of patients may experience long-term back pain following primary discectomy for radiculopathy. 3–5 Progressive disc degeneration

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Simon Thorbjørn Sørensen, Rachid Bech-Azeddine, Søren Fruensgaard, Mikkel Østerheden Andersen, and Leah Carreon

L umbar disc herniation (LDH) is a common disease with a prevalence of 2%–3%, and the highest incidence for men in the 4th to 5th decade of life. 1 LDH traditionally presents with radicular pain in the lower extremities, also known as sciatica, but can also cause low-back pain (LBP). Most patients with LDH can be treated nonsurgically. Nonoperative treatment normally includes analgesics, physiotherapy, chiropractic manipulation, and, at certain facilities, epidural steroid injections. 2 In some cases, surgery is indicated due to neurological deficit, untenable

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Dana L. Cruz, Ethan W. Ayres, Matthew A. Spiegel, Louis M. Day, Robert A. Hart, Christopher P. Ames, Douglas C. Burton, Justin S. Smith, Christopher I. Shaffrey, Frank J. Schwab, Thomas J. Errico, Shay Bess, Virginie Lafage, and Themistocles S. Protopsaltis

board–approved, single-center (NYU Langone Medical Center), retrospective analysis of data prospectively collected from consecutive patients seen at an outpatient spine center from 2014 to 2016. Inclusion criteria were patients 18 years or older at the time of the office visit presenting with at least one of the following complaints: back pain, neck pain, self-reported history of spinal deformity, or other spine-related complaint. Exclusion criteria were anticipated noncompliance with survey completion and patients who were expected to undergo a surgical or

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Salah G. Aoun, Valery Peinado Reyes, Tarek Y. El Ahmadieh, Matthew Davies, Ankur R. Patel, Vin Shen Ban, Aaron Plitt, Najib E. El Tecle, Jessica R. Moreno, Jack Raisanen, and Carlos A. Bagley

L ow-back pain is a leading cause of disability in the United States and carries a heavy socio-economic toll. The drain on the healthcare system is significant, and the annual cost is estimated at more than $500 billion, 19 compared to $327 billion for diabetes, 2 and $131 billion for hypertension. 12 The population at risk is part of the active workforce, with a prevalence of the disease of up to 45%. 3 Given the magnitude of the impact of this disease, it is not surprising to see significant effort and time dedicated toward the diagnosis and treatment of

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Gordon Li, Chirag Patil, John R. Adler, Shivanand P. Lad, Scott G. Soltys, Iris C. Gibbs, Laurie Tupper, and Maxwell Boakye

L ow-back pain is a major public health problem with significant socioeconomic impact that costs society upwards of $50 billion annually. 12 , 30 , 44 About 80% of people will experience at least one episode of low-back pain in their lifetimes, and their pain will recur at rates of 20–44% annually, 80% over 10 years, and 85% over their lifetimes. 1 , 24 , 30 For most patients, back pain has no clear, identifiable cause. In a significant number of patients there is evidence of degenerative spinal changes, but such changes may also be present in

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Hernando Rafael

Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well