Spine
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This experimental study was designed to test the hypothesis that posterior spinal fusion and internal fixation, using a stiff transpedicular construct, would withstand additional anterior column growth without the need for an anterior procedure and would prevent the development of deformity secondary to asymmetric growth of the anterior column in the immature canine model. ⋯ The present study confirmed that in immature canines anterior column growth continues after posterior fusion without instrumentation. The magnitude of this growth, combined with a posterior tether, is sufficient to cause significant lordosis. The results are the first to document that a stiff posterior spinal instrumentation system is sufficient to overpower the residual anterior growth centers, even in the presence of a posterior tether (fusion mass). This technique creates a mechanical epiphysiodesis evidenced by arresting vertebral body length, narrowing disc space, and preventing lordosis, thus thwarting the deformity-producing mechanism without an additional anterior procedure.
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A cost-effectiveness analysis of lumbar discectomy based on existing efficacy data and newly gathered cost data. ⋯ For carefully selected patients with herniated discs, surgical discectomy is a cost-effective treatment. Discectomy's favorable cost-effectiveness results from its substantial effect on quality of life and moderate costs.
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Multicenter Study Clinical Trial Controlled Clinical Trial
Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years' follow up.
Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. ⋯ Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.
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Clinical Trial Controlled Clinical Trial
Increased limb lengths in patients with shortened spines due to tuberculosis in early childhood.
The spine and limb lengths of 26 patients who had a severe spinal deformity due to tuberculosis in childhood were measured and compared with similar data from 79 normal adult volunteers. ⋯ Patients whose spinal growth was stunted due to disease in childhood have longer legs and upper limbs than healthy people. A compensatory stimulatory growth mechanism may be responsible for this. This has implications for the whole gamut of childhood spinal disorders that result in stunted spinal growth.