Spine
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Comparative Study Clinical Trial
Adolescent disc protrusions. A long-term follow-up of surgery compared to chymopapain.
This study compared chymopapain with primary surgery in the treatment of 60 radiologically proven adolescent lumbar disc protrusions and symptoms of low back pain and sciatica; the failures of intradiscal therapy were treated by surgical discectomy. ⋯ Back pain, radicular pain, and tension signs are common, but neurologic signs are less frequent in this age group. Long-term results of surgery are no better than the results of first-line chymopapain treatment with surgery being reserved for the failures. In 60% to 70% of patients, the morbidity, cost, and hospital stay were lessened. The patient is more likely to be in satisfactory employment after chemonucleolysis than after primary surgery.
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Telephone interviews were conducted with a random sample of adults in 4437 North Carolina households. The response rate was 79%. ⋯ Acute back pain is common. Care is often sought regardless of income and insurance status. Seeing a health care provider for acute back pain may not be discretionary from the perspective of the patient.
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Biography Historical Article
Victor Horsley's surgery for cervical caries and fracture. The Centennial Anniversary.
On August 25, 1895, Victor Horsley, the doyen of British neurosurgery, presented the results of his surgery for trauma and caries (tuberculosis) of the cervical spine at the Surgery Section of the British Medical Association Annual Meeting. All of the patients recovered from their operations and four were in attendance at the meeting to attest to the results of their operations. ⋯ The special relationship of Victor Horsley with William Gowers, neurologist of Queen's Square Hospital, London, is presented. The status of therapy for cervical fracture and tuberculosis at the close of the 19th century is described to gauge the magnitude of this event as a major contribution to the progress of spinal surgery.
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To enhance the awareness of physicians treating whiplash patients, findings from previous research regarding cognitive functioning of these patients are discussed and recommendations for assessment provided. Cognitive disturbances (i.e., deficient attentional functioning and impairment of memory) are frequent complaints in patients after whiplash injury. ⋯ Accordingly, cognitive disturbances after whiplash show a fair rate of recovery, which parallels recovery from trauma-related somatic symptoms. Current research does not indicate disturbances in higher cognitive functions after whiplash.
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Herniated lumbar disc specimens were obtained from patients undergoing surgical discectomy for persistent radiculopathy and cultured in vitro to determine whether various biochemical agents were being produced. ⋯ Herniated lumbar discs were making spontaneously increased amounts of matrix metalloproteinases, nitric oxide, prostaglandin E2, and interleukin-6. These products may be involved intimately in the biochemistry of disc degeneration and the pathophysiology of radiculopathy. Their exact roles certainly need further investigation, but their mere presence implicates biochemical processes in intervertebral disc degeneration.