Spine
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A retrospective clinical study of patients with vertebral osteomyelitis of the lumbar spine necessitating surgical treatment. All patients underwent sequential (same-day) or simultaneous anterior decompression and posterior stabilization of the involved vertebrae. ⋯ Patients with lumbar osteomyelitis necessitating surgery can undergo combined, same-day surgery either in a sequential or simultaneous manner. This is a safe and efficient way to control the infection and stabilize the affected segments, allowing for early mobilization of these sick elderly patients.
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Randomized Controlled Trial Clinical Trial
The ability of lumbar medial branch blocks to anesthetize the zygapophysial joint. A physiologic challenge.
Randomized, controlled, single blinded study. ⋯ There was a significant effect of 2% lidocaine (versus saline) medial branch injections on anesthetization of the zygapophysial joint when venous uptake was avoided during these injections. When properly performed, lumbar medial branch blocks successfully inhibit pain associated with capsular distention of the lumbar zygapophysial joints at a rate of 89%.
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Fifteen specimens of the first cervical vertebra were tested by the application of pure tensile forces to failure. Seven specimens had intact transverse ligaments, and eight had transection of the transverse ligament before testing. Specimens were tested to failure by the rapid application of laterally directed tensile force to the ring; this force then was exerted through the lateral masses to simulate the mechanism of injury for this fracture as proposed by Jefferson. ⋯ The results of this study show that fractures of the C1 ring of greater than two parts can occur with pure tensile loading. The ring will fracture with as little as 1 mm of deformation.
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Randomized Controlled Trial Comparative Study Clinical Trial
One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.
A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. ⋯ Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.
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Fifty-seven patients with dens fractures were identified from 1986 to 1996 at the authors' institution. Forty-six were available for reevaluation by two independent observers with a mean follow-up period of 26 months. ⋯ Patients over 60 years of age with a dens fracture had a higher complication rate and lower cervical range of motion when treated conservatively with a halo. Final functional outcome and overall pain levels, however, did not differ significantly by age group or treatment modality.