Spine
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Comparative Study
Differential biomechanical effects of injury and wiring at C1-C2.
An in vitro study compared the biomechanics of the upper cervical spine among three groups of cadaveric specimens, each with a different source of instability: transverse-alar-apical ligament disruptions, odontoid fractures, or odontoidectomies. The responses of the three groups were again compared after a uniform posterior cable and graft fixation was applied to the specimens. ⋯ The three different injuries produce different spinal biomechanical responses. To best promote fusion, posterior cable and graft fixation should be used with an adjunctive stabilizing technique to treat all three injuries.
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This is a retrospective review of all patients requiring either Cotrel-Dubousset or Moss Miami rod removal. All initial spinal instrumentations were for adolescent idiopathic scoliosis from 1985 through 1994. Twenty-two patients who underwent rod removal for late-developing infection constitute the study group. ⋯ Late-appearing infection with spinal instrumentation can be treated with device removal, primary skin closure, and short-term oral antibiotics. The infections affect soft tissue, not the bone.
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The risk factors for complications and complication and survival rates in patients with metastatic disease of the spine were reviewed. A retrospective study was performed. ⋯ The likelihood that a complication occurred was significantly related to Harrington classifications demonstrating significant neurologic deficits and the use of preoperative radiation therapy. In general, Harrington classifications with neurologic deficits and lower Frankel grades before and after surgery were associated with an increased risk of complication. Overall, the major complication rate was relatively low, and minor complications were successfully treated with minimal morbidity. The relatively long survival time after spinal surgery in this group of patients justifies surgical treatment for metastatic disease. Most complications occurred in a small percentage of patients. To minimize complications, patients must be carefully selected based on expected length of survival, the use of radiation therapy, presence of neurologic deficit, and impending spinal instability or collapse caused by bone destruction.
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Randomized Controlled Trial Clinical Trial
Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.
A prospective double-blind randomized trial in 31 patients. ⋯ Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain, both on a short-term and a long-term basis.
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Comparative Study Clinical Trial
Impact of the type of brace on the quality of life of Adolescents with Spine Deformities.
A group of 102 brace-treated adolescents, aged 10-19 years with spine deformities participated in a cross-sectional study. ⋯ In cases of different orthoses of proven similar effectiveness in controlling the scoliotic curves, the use of bracing with the lowest impact on the quality of life should be recommended.