Spine
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Case Reports Multicenter Study Comparative Study
Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.
A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. ⋯ Patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. Patients in whom infection develops are then at increased risk for pseudarthrosis.
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Comparative Study
Impact response of the intervertebral disc in a finite-element model.
A three-dimensional nonlinear poroelastic finite-element model of a vertebra disc was used to analyze the biomechanical effects of impact loading on the spinal segment. ⋯ The finite-element technique was used to address the role of impact duration in producing trauma to the spinal motion segment. Within the limitations of the model, the results suggest that fractures are likely to occur under shorter impact duration conditions. Depending on the strength of the region, a fracture may be initiated in the endplate region or the posterior wall of the cortical shell. The nucleus pressure is independent of the impact duration and depends only on the magnitude of the impact force.
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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.