Spine
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Advances in transport, imaging, and stabilization of the injured patient have made the topic of acute management more important than ever in patients with spinal cord injury. Optimal treatment requires prompt delivery of care for life-threatening respiratory and hemodynamic events in a manner that will not further damage the unstable spinal elements. The application of these treatment principles broadly to injured patients is necessitated by our inability to determine, on an acute basis, those patients who might eventually recover meaningful neurologic function from those who will not. ⋯ The second includes the application of resuscitative measures without further damaging the spinal cord and, in some cases, the use of traction and immobilization. In the past these efforts were aimed primarily at increasing the survival rate of patients with spinal cord injury, whereas current care may also play an important role in the eventual recovery of neurologic function. Despite many advances in our understanding of the basic mechanisms of paralysis, clinical management of spinal cord injury remains a significant challenge and one that requires continuing efforts at improving acute and postacute therapies.
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Retrospective chart and radiographic review of all cases admitted to the authors' hospital and diagnosed to have tuberculous spondylitis. ⋯ Tuberculous spondylitis is prevalent in the authors' hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.
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A reliability and validity study of a previously translated version of the Roland-Morris Disability Questionnaire (RMDQ). ⋯ The RMDQ is a robust unidimensional ordinal measure, largely free of differential item functioning, which works well in the Turkish population. Nonparametric effect sizes of ordinal scales are found to overestimate or underestimate the true effect size depending on the nature of the scale and the distribution of patients at baseline.
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Randomized Controlled Trial Multicenter Study Clinical Trial
The Sygen multicenter acute spinal cord injury study.
Randomized, double-blind, sequential, multicenter clinical trial of two doses of Sygen versus placebo. ⋯ Although not proven in the primary efficacy analysis of this trial, Sygen appears to be beneficial in patients with severe spinal cord injury.