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Biomedical subjects

Perry A Ball

Publications and source records attributed to Perry A Ball.

3 recordsLinked to original sources

Minimally invasive fusion: summary statement.

Ideally, minimally invasive surgery (MIS) allows less extensive manipulation of surrounding tissues than a conventional open procedure while accomplishing the same goals and objectives at the target structure. Long-term follow-up combined with appropriate outcome measures are necessary to prove the safety and effectiveness of MIS. For MIS procedures to be widely adopted, they must have an acceptable learning curve. Special skills are needed and are beyond those of traditional open surgery, By definition, as compared with conventional open surgeries, minimally invasive procedures typically involve smaller incisions and less extensive surgical manipulation of the tissues that surround the target structure. Ideally, once the target structure has been reached, the minimally invasive procedure should accomplish the same goals and objectives as its open surgical counterpart. Thus, although minimally invasive surgeries are aimed at reducing the morbidity associated with open surgical approaches, they should not hinder the surgeon's ability to perform a successful operation. In other words, minimal invasion should not equate to minimally effective.

Clinical Competence↗

An observational study on the prevalence and pattern of opioid use in 25,479 patients with spine and radicular pain.

STUDY DESIGN: A cross-sectional analysis of data obtained from patients with spinal and radicular pain and their spine center treating physicians was performed. OBJECTIVES: To identify characteristics of patients treated with opioids that distinguish them from similar patients not treated with opioids in a large population of patients with spine and radicular pain, and to determine the prevalence of opioid use. SUMMARY OF BACKGROUND DATA: The use of opioids with patients who have chronic pain remains controversial. The long-term risks and benefits are poorly described. The efficacy of this treatment has not been proved, yet the large majority of pain specialist physicians manage chronic pain with opioids. METHODS: Descriptive data from the initial visits of 25,479 patients with spinal pain were reviewed. Patients were grouped according to whether or not opioids were recommended, prescribed, or continued. The prevalence of opioid use and patient characteristics were compared using standard statistical tests. RESULTS: Overall, 3.4% of the patients had opioids included in their plan of care. There was no difference in age, gender, education, or compensation status between the two groups. Patients were more likely to be treated if the duration of their symptoms had been less than 3 months. However, 75% of the patients with opioids in their plan had experienced symptoms longer than 3 months. A greater incidence of objective findings was identified in the opioid group. CONCLUSIONS: The authors cannot comment on the prevalence of opioid use because, to the best of their knowledge, no other similar studies are available for comparison.

Cross-Sectional Studies↗

Split cord malformation as a cause of tethered cord syndrome in a 78-Year-old female.

A 78-year-old woman presented for evaluation of back pain, urinary dysfunction, leg weakness and progressive equinovarus foot deformity. She reported that shortly after her birth in 1924, she underwent resection of a subcutaneous 'cyst' in the lower lumbar area. Seven years prior to evaluation at our institution, she had undergone bilateral total knee arthroplasty for osteoarthritis. After the procedure, she began to experience severe low back pain that radiated into her legs. Weakness of the foot inverters, urinary dysfunction and worsening bilateral equinovarus foot deformity developed in the years following the surgery. MRI revealed a split cord malformation with a tethered spinal cord. Because of the patient's age and poor medical condition, her symptoms were managed conservatively. This case demonstrates symptomatic deterioration in an elderly patient with a tethered spinal cord after many years of clinical stability.

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