Spine
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Comparative Study
Herniated lumbar disc material as a source of free glutamate available to affect pain signals through the dorsal root ganglion.
Combined prospective human cohort and prospective controlled animal model. ⋯ Glutamate originating from degenerated disc proteoglycan may diffuse to the dorsal root ganglion and effect glutamate receptors. Consideration may be given to treating disc radiculopathy with epidural glutamate receptor antagonists.
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Comparative Study
Complications of pedicle screw fixation in reconstructive surgery of the cervical spine.
Retrospective evaluation of complications in 180 consecutive patients with cervical disorders who had been treated by using pedicle screw fixation systems. ⋯ The incidence of the clinically significant complications caused by pedicle screw insertion was low. Complications associated with cervical pedicle screw fixation can be minimized by sufficient preoperative imaging studies of the pedicles and strict control of screw insertion. Pedicle screw fixation is a useful procedure for reconstruction of the cervical spine in various kinds of disorders and can be performed safely.
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Randomized Controlled Trial Comparative Study Clinical Trial
Early aggressive exercise for postoperative rehabilitation after discectomy.
A randomized clinical trial of postoperative medical exercise therapy in patients after operation for lumbar disc herniation with blind assessment of clinical outcomes. ⋯ Vigorous medical exercise therapy, started 4 weeks after surgery for lumbar disc herniation, reduced disability and pain after surgery. Because no differences in clinical end points were observed, there is hardly any danger associated with early and vigorous training after operation for disc herniation.
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Comparative Study
Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials.
Motor-evoked potentials (MEPs) were analyzed using transcranial electrical stimulation during spinal surgery in patients under ketamine-based anesthesia, with and without propofol. ⋯ If a train of pulses were used for transcranial stimulation, low-dose propofol can be effectivelyused as a supplement to ketamine-based anesthesia during intraoperative monitoring of myogenic MEPs. Addition of propofol significantly reduced the ketamine-induced psychedelic effects.
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This is a prospective test-retest repeatability study. ⋯ As reported by others, the intraevaluator repeatability was high. The results of this study, finding acceptable repeatability for most scoring methods for pain drawing completed on occasions separated by a relatively long period of time, support that the pain drawing is a stable instrument for use in chronic back pain patients.