Spine
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Comparative Study
The effect of litigation status on adjustment to whiplash injury.
This retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident. ⋯ That litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.
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This study analyzed two groups of subjects during forward bending. Group 1 (n = 20) contained subjects with a history of low back pain and Group 2 (n = 21) included subjects without a history of low back pain. ⋯ The results provide quantitative data to guide clinical assessment of forward bending motion. Results also suggest that although people with a history of low back pain have amounts of lumbar spine and hip motion during forward bending similar to those of healthy subjects, the pattern of motion is different. It may be desirable to teach patients with a history of low back pain to use more hip motion during early forward bending, and hamstring stretching may be helpful for encouraging earlier hip motion.
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Retrospective review and prospective follow-up of 88 patients who had decompressive laminectomy with or without fusion from 1983 to 1986. ⋯ Seven to 10 years after decompressive surgery for spinal stenosis, 23% of patients had undergone reoperation and 33% of respondents had severe back pain. Despite a high prevalence of nonspinal problems in this elderly cohort, spinal symptoms were the most important correlate of reduced functional status.
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Comparative Study
Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography.
This study correlated a specific lumbar disc abnormality described as the high-intensity zone observed on high-field magnetic resonance imaging with discography. ⋯ In patients with symptomatic low back pain, the high-intensity zone is a reliable marker of painful outer anular disruption.
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Biography Historical Article
Historical perspective Brown-Sequard and his work on the spinal cord.
Charles Edouard Brown-Sequard was born in Mauritius in 1817, graduated as a physician in Paris in 1846, was a founder-physician of the National Hospital (for Neurology and Neurosurgery) in England, and held the Chair of Physiology and Pathology of the Nervous System at Harvard College before succeeding Claude Bernard as professor of medicine at the College de France in Paris, where he remained until his death in 1894. Erratic and unpredictable, he spent much of his life in traveling between Europe and the United States, married three times, fathered three children, authored almost 600 scientific publications, and was the founder-editor of three journals. Widely regarded as a founder of modern endocrinology, his work on tissue extracts toward the end of his career brought scorn and derision from colleagues and much of the lay public, but was the foundation of modern hormone replacement therapy. ⋯ He initially showed that these pathways are not confined to the posterior columns and that certain sensory fibers decussate soon after their entry into the spinal cord, and he subsequently described the clinical features of the syndrome now named after him. In his later life, he modified his views to suggest that dynamic spinal mechanisms are responsible at least in part for the sensory changes resulting from spinal cord lesions, stressing that any deficit is not simply the result of the interruption of a hard-wired system. The clinical implications of these views are profound, but this aspect of his work has been virtually ignored until very recently.