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Purpose: The optimal management of patients with compressive radiculopathy with motor deficit (CRMD) is controversial. Our goal was to provide evidence on the impact of the spine surgeons' experience on surgical planning and timing. Methods: Spine surgeons were invited to participate in a 5-item online survey. A literature review was carried out. Results: Of the 94 spine surgeons who responded to the survey, 70% would operate early on a patient with acute CRMD, but only 48% would do so if the radicular pain had resolved. Surgeons with more than 15 years of experience chose more conservative options. Twenty published studies were selected in the literature review. Conclusion: The optimal management of patients with compressive radiculopathy associated with a non-progressive motor loss remains unknown. The results of our survey show that surgeons with extensive surgical experience take a more conservative and cautious approach. [ABSTRACT FROM AUTHOR]

Seventy-five percent of the human population will live in urban areas by 2050, and urban vegetation will be the main source of ecosystem services. Unequal access to urban vegetation might exacerbate existing socioeconomic differences. Studies performed in cities of developed countries show that the population with higher socioeconomic status has more access to ecosystem services provided by vegetation. In urban areas, with small internal climatic variation, plant productivity measured through satellite imagery is a good indicator of vegetation availability that can be mapped. In this study, we characterized the distribution of plant productivity in 40 Argentine urban centers and we identified socio-environmental variables that control its spatial patterns within and among urban centers. We used socioeconomic indicators obtained from the 2010 National Population and Households Census and a 4-year mean plant productivity measured through the integration of NDVI values derived from MODIS satellite images. In most of the analyzed cities, plant productivity increased as socioeconomic status decreased; and only in 25% of the cities, we found a positive relationship between socioeconomic status and plant productivity. In the latter case, most of the cities were placed in arid environments, where both the cost of watering and the effect of subsidized water on plant productivity are proportionally higher. Buenos Aires and Bariloche, which also showed positive associations between socioeconomic status and plant productivity, are located in humid environments, but Buenos Aires is the most densely populated city of Argentina and Bariloche is a touristic city; in these cities, the relative cost of keeping green spaces instead of building housing infrastructure is also high. These results show that vegetation distribution among socioeconomic status is more diverse than suggested by the literature and that the appropriation of vegetation productivity by groups with higher socioeconomic status only occurs when vegetation cost increases to the point of becoming a luxury good. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether patients undergoing lumbar spine surgery for the first time (Group 1) had different expectations from those undergoing lumbar spine surgery for a failed previous procedure (Group 2).Methods: A prospective study that included 77 patients. A set of self-reported questionnaires was pre-operatively administered including VAS, Oswestry Disability Index (ODI), Zung Depression Scale and the NASS lumbar spine questionnaire (expectations scale).Results: Fifty-six patients in Group 1 and 21 patients in Group 2. Both groups had high expectations with regard to the surgical procedure (n.s.). Depressed patients, despite being more disabled than non-depressed according to ODI (p 0.001), had similar expectations than non-depressed patients (n.s.).Conclusion: Patients' expectations remained very high despite having had a failed previous surgery for the same procedure. [ABSTRACT FROM AUTHOR]

Objectives: To assess the changes of intradiscal pressure at the bridged and at the adjacent levels to a lumbar two-level hybrid instrumentation. Introduction: The elimination of motion produced by spinal fusion may have potential consequences beyond the index level overloading the juxtaposed spinal motion segments and leading to the appearance of degenerative changes. Degeneration of the segments adjacent to instrumented levels has become a topic of increasing interest in the literature over the last years. In order to prevent degenerative disc changes at the adjacent segments to a fused level, a broad scope of techniques have been developed, one of them is hybrid constructs. Methods: In 6 human cadaveric lumbosacral specimens, pressure transducers quantified intradiscal pressure changes at three levels (L3-L4, L4-L5 and L5-S1) under axial compression (0-750 N), anterior flexion (+12°) and extension (−12°) in three different situations of spinal stability: intact, L5-S1 rigid rod pedicle screw instrumentation and L4-S1 two-level hybrid instrumentation (rigid at L5-S1 and dynamic at L4-L5). Results: Once the L5-S1 segment had implanted the rigid instrumentation system (Diapason), the intradiscal pressure at this level decreased by 65 % while the intradiscal pressure at the disc above (L4-L5) increased 20 %. After augmenting the L5-S1 posterior construct with a dynamic stabilization device (Dynesys) at the superior adjacent level, the intradiscal pressure at this level, L4-L5, decreased by 50 % whereas intradiscal pressure at its adjacent level, L3-L4, only experienced a slight increase of 10 %. Conclusions: The raise of intradiscal pressure at the adjacent segment to a rigid instrumented segment can be reduced when the rigid construct is augmented with a dynamic stabilization device. Hybrid constructs might have a possible protecting role preventing the occurrence of degenerative disc changes at the adjacent segment to a rigid instrumented level. Augmentation with a dynamic stabilization device might protect the disc above a rigid rod pedicle screw construct. [ABSTRACT FROM AUTHOR]