Spine
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The influence of ketorolac on spinal fusion was studied in a retrospective review of 288 patients who underwent an instrumented spinal fusion. ⋯ These data suggest that nonsteroidal anti-inflammatory drugs significantly inhibit spinal fusion at doses typically used for postoperative pain control. The authors recommend that these drugs be avoided in the early postoperative period.
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Comparative Study
Multicycle mechanical performance of titanium and stainless steel transpedicular spine implants.
This was a prospective in vitro study comparing titanium alloy and stainless steel alloy in transpedicular spine implants from two different manufactures. ⋯ A transpedicular spine implant's fatigue lifetime depends on both the design and the material and cannot be judged on material alone. Stainless steel implants are stiffer than titanium alloy implants of equal design and size; however, for those designs in which the fatigue life of the titanium alloy version is superior, enlargement of the implant's components can compensate for titanium's lower modulus of elasticity and result in an implant equally stiff as its stainless steel counterpart. Such an implant made from titanium alloy would then be clinically preferable because of titanium's previously reported imaging advantages.
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A prospective evaluation of the incidence of low back pain in college athletes was undertaken. ⋯ Athletes with lower extremity acquired ligamentous laxity or overuse may be at risk for the development of noncontact low back pain during athletic competition. Female athletes with lower extremity involvement appeared to have a higher incidence of low back pain treatment compared with their male counterparts. Inflexibility of the lower extremities or leg length discrepancy were not associated with future low back pain treatment.
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A survey of a random sample of 1002 members of the Royal Canadian Mounted Police to determine their experience with low back pain. ⋯ The prevalence of low back pain in this police force is comparable with that in the general population, and driving a patrol car or wearing the duty belt does not appear to influence the prevalence rate in this population.
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Population-based cohort study of Washington State patients who underwent lumbar spine surgery for degenerative conditions in 1988. ⋯ As in previous studies, complications in the current study occurred more frequently among patients who underwent lumbar spine fusion than among those who underwent laminectomy or discectomy alone. Reoperations were at least as frequent after fusion, but the authors could not assess treatment efficacy in terms of pain relief or improved function. Although the characteristics of patients undergoing fusion differed from those undergoing a laminectomy or discectomy alone, there appeared to be sufficient overlap in the clinical populations to warrant closer scrutiny of the safety, efficacy, and indications for spinal fusions, preferably in randomized trials.