Spine
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Comparative Study
Patient characteristics and patterns of use for lumbar spine radiographs: results from the Veterans Health Study.
Longitudinal data from the Veterans Health Study, an observational study of male patients receiving Veterans Administration ambulatory care, were analyzed. ⋯ Both physical and psychological factors contribute to having new radiographic examinations, whereas psychological factors have increased importance in the repeat use of roentgenographic examinations. Repeat radiographs appear to be overused, judging by the severity of physical impairment as measured by low back pain intensity, the Medical OutcomeStudy Short Form Health Survey, and disability days.
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A retrospective review of a clinical series was performed. ⋯ Spinal implant removal after long posterior fusion in adults may lead to spinal collapse and further surgery. Removal of instrumentation should be avoided or should involve partial removal of the prominent implant.
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Comparative Study
Differences in repositioning error among patients with low back pain compared with control subjects.
Trunk repositioning error was measured in 20 patients with chronic low back pain and 20 control subjects. ⋯ The increase in repositioning error of patients with low back pain during flexion implies that some aspects of proprioception are lost in patients with low back pain. The decrease in repositioning error in patients with low back pain in extension is not as easily explained, but could possibly be caused by increased activation of mechanoreceptors in facet joints.
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Nerve root stimulation thresholds were studied relative to the level of neuromuscular blockade in patients undergoing lumbar decompression surgery. ⋯ Neuromuscular blockade should be less than 80% when using pedicle screw electrical stimulation testing.
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Comparative Study
Fos expression in the rat brain and spinal cord evoked by noxious stimulation to low back muscle and skin.
Acute noxious stimulation delivered to lumbar muscles and skin of rats was used to study Fos expression patterns in the brain and spinal cord. ⋯ The finding that Fos-immunoreactive neurons were absent from lamina II of the spinal cord in the deep pain group is similar to that of the projection pattern of the visceral pain pathway. Fos expression in the ventrolateral periaqueductal gray in the deep pain group may represent a reaction of quiescence and a loss of interest, activities, or appetite. Furthermore, the detection of large numbers of Fos-immunoreactive neurons in the core of accumbens nucleus, basolateral nucleus of amygdala, paraventricular hypothalamic nucleus, and ventral tegmental area in the deep pain group may suggest a dominant reaction of dopaminergic neurons to stress, and a different information processing pathway than from that of cutaneous pain.