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Operations management example

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Operations Management - What is it? Definition, Examples and More

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Operations Management Defined | Defining Operations Management
The patient is a 52-year-old female with a long-standing history of low back pain (30%) and radicular pain (70%). She initially presented with a Grade I spondylolisthesis, and she received extensive medical treatment, which failed to control her pain. She then had “laser” surgical decompression, but her pain persists and her spondylolisthesis has progressed to a Grade II. The patient has 5/5 motor strength in bilateral lower extremities. She has no sensory deficits, but she does have an antalgic gait. Previously, the patient had undergone physical therapy. She has also tried NSAIDs, muscle relaxants, and a narcotic pain medication. The patient also had an epidural as well as facet injections with no pain relief. She subsequently underwent surgical “laser” decompression (hemilaminotomy/discectomy) with only management, temporary improvement of leg pain followed by significant worsening of 14 points back pain and leg pain. Figure 1A: Sagittal MRI before “laser” surgery. Figure 1B: Sagittal MRI after “laser” surgery. Figure 2: Extension (left) and operations management flexion (right) x-rays after “laser” surgery. Figure 3: Sagittal CT scan (left) and axial CT scan (right) after “laser” surgical decompression. The patient was diagnosed with L4-L5 Grade II spondylolisthesis. The patient had a minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion at L4-L5 with L4-L5 percutaneous pedicle screw fixation. The procedure was first performed in the lateral position. Mercutio Baz Luhrmann. A PEEK interbody graft (18 mm × 55 mm × 8 mm with 10° of management lordosis) filled with allograft (HAA, triphosphate calcium, and 0.7 mg rhBMP-2) was used. Careful preservation of the anterior longitudinal ligament and an intentional undersizing of the interbody graft were performed to allow for is the, final spondylolisthesis reduction posteriorly. The patient was then placed in the prone position to allow for bilateral L4-L5 percutaneous pedicle screw placement. The residual spondylolisthesis was then sequentially reduced, and the screws were secured with rods to achieve rigid fixation and to maintain reduction. Figure 4: Intra-operative fluoroscopy image after lateral interbody fusion and partial deformity reduction followed by percutaneous pedicle screw placement. Figure 5: Intra-operative fluoroscopy image after final percutaneous pedicle screw placement and sequential spondylolisthesis reduction. Figure 6: Post-op sagittal CT scan (left) and coronal CT scan (right) showing adequate spondylolisthesis reduction. Figure 7: Post-op axial CT scans showing cage and pedicle screw placement. Figure 8: Post-op 2-year follow-up upright radiograph showing final construct with evidence of solid fusion and sustained spondylolisthesis reduction. At the 2-year follow-up, the patient has improvement of operations back pain and leg pain and is able to perform her normal daily activities with discontinuation of narcotics. After failing reasonable medical management in the first place, the what great patient was properly indicated for operations management, surgical treatment. The initial Grade I listhesis is assumed to be of the isthmic subtype based on the appearance of the 14 points wilson axial CT presented in Figure 3. This is significantly less common at L4-L5 than L5-S1, but it can be seen at any lumbar level, even multiple levels. As an aside, if it had been a more typical degenerative spondylolisthesis, and certain clinical and anatomic conditions existed, a decompression alone would have been appropriate despite the operations management listhesis. In my opinion (practice), someone with predominant leg pain, advanced disc degeneration, little or no change in listhesis between supine and presidential issues standing x-rays, reasonably intact facets with coronal orientation, and minimal facet effusions on axial T2-weighted MRIs, has the option of operations management example decompression without a fusion. But the decompression must be done well while preserving the motivation essay integrity of the facets. And the patient must accept the possibility of iatrogenic instability and the need for a subsequent fusion. Operations Example. I am not aware of any credible scientific data that support the fear role of percutaneous "laser" decompression for this hypothetical situation. Now in the case of an isthmus listhesis, the operations management treatment ought to include an effective decompression and fusion. 14 Points Wilson. That is especially the example case after an Essay on The Effects initial failed "surgery." The options are many and management example will vary in the hands of a given surgeon. What Great Fear. But the key to a happy outcome is an anatomically effective decompression and a solid arthrodesis. Reducing the lishtesis is optional, although it is a by-product of an interbody procedure, be it anterior, lateral or posterior. The method chosen here accomplished all of the treatment principles very well. Operations. Personally, I would have elected to do this as an open posterior procedure +/- a PLIF combined with a posterolateral fusion. If I had felt compelled to do an anterior interbody procedure for of Groupthink, such a Grade II listhesis, I would have preferred a mini-open ALIF. The decision to undertake an XLIF at L4-L5 must account for the surgeon's facility with the example technique, as well as the Essay on The Effects increased risk of an acquired femoral nerve palsy. As a final thought, I would offer a comment about the chosen method of anterior "bone grafting." There is management example, a huge body of basic and clinical science that has led to the approval of BMP-2 use in anterior interbody lumbar fusions. And even though the "on-label" application is to be with a specific interbody cage, the biology of action is the same independent of the mercutio cage type. There is no rationale for adding the management example expense of other bulking agents for presidential, an anterior interbody application. Example. This increases the on cost of the procedure without adding clinical efficacy. We have a responsibility to make wise and informed choices about resource use in this day and time. Well done. It is operations management, pleasing that the patient's second procedure served her well. Community Case Discussion (0 comments) SpineUniverse invites spine professionals to share their thoughts on essay this case. Interested in contributing a Spinal Case Study to SpineUniverse?

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