Spine
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The superficial and deep lamina of the posterior layer of the thoracolumbar fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster photography. ⋯ Anatomic structures normally described as hip, pelvic, and leg muscles interact with so-called arm and spinal muscles via the thoracolumbar fascia. This allows for effective load transfer between spine, pelvis, legs, and arms--an integrated system. Specific electromyographic studies should reveal whether the gluteus maximus muscle and contralateral latissimus dorsi muscle are functionally coupled, especially during rotation of the trunk. In that case, the combined action of these muscles assists in rotating the trunk, while simultaneously stabilizing the lower lumbar spine and sacroiliac joints.
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Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
The effect of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusions in patients with degenerative disc disease.
A prospective, multi-center Investigational Device Exemption Study was carried out in the United States using a pedicle screw and plate system to perform a fusion in patients with degenerative disc disease or spondylolisthesis. The patients' pain function, complications, and fusion status were evaluated and compared with literature controls. ⋯ A statistical analysis showed that patients with degenerative disc disease who underwent fusion without pedicle screw instrumentation were over 24 times more likely to have a pseudarthrosis than comparable patients implanted with a pedicle screw/plate system. Regarding the most important goal in performing a spinal fusion--fusion of the spine--the pedicle screw/plate system used in this study was shown to be a safe and efficacious method of facilitating fusion with autogenous bone graft for this patient population.
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This report is a preliminary description of the efficacy of video-assisted thoracoscopic surgery in thoracic spinal procedures that otherwise require open thoracotomy. ⋯ Given consistently improving surgical skills, a number of thoracic spinal procedures using video-assisted thoracoscopic surgery, including thoracic discectomy, internal rib thoracoplasty, anterior osteotomy, corpectomy, and fusion, can be performed safely with no additional surgical time or risk to the patient.
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Case Reports
Resolving disputes under the Americans with Disabilities Act. A case example of an employee with a back impairment.
To illustrate the importance of proactive medical professional participation in Americans with Disabilities Act reasonable accommodation cases, this article describes the use of alternative dispute resolution techniques to resolve a case involving a blue collar employee with a work-related lower back injury. The problems in accommodating employees with back and spine injuries are being experienced by many employers. To date, the largest number of discrimination claims filed with the Equal Employment Opportunity Commission under the Americans with Disabilities Act involve individuals with back and spine impairments. This article identifies eight decision-points in the Americans with Disabilities Act accommodation process that are relevant to employers, persons with disabilities, medical professionals, union representatives, and legal counsel.
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Biography Historical Article
Pierre Marie. Pioneer investigator in ankylosing spondylitis.