Spine
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Case Reports
Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain.
Case report of surgically treated mechanical low back pain from the facet joint contralateral to a unilateral anomalous lumbosacral articulation (Bertolotti's syndrome). ⋯ Clinicians should consider the possibility that mechanical low back pain may occur from a facet contralateral to a unilateral anomalous lumbosacral articulation, even in a young patient. Although reports of surgical treatment of Bertolotti's syndrome are infrequent, resection of the anomalous articulation provided excellent results in this patient, presumably because of reduced stresses on the symptomatic facet.
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The significance of occipitoaxial angle in the development of subaxial subluxation after occipitocervical fusion was determined in a minimum 5-year follow-up study performed retrospectively. ⋯ It is necessary to give attention to the position of the fixed occipital bone and axis during procedures of occipitoaxial fusion for patients with rheumatoid arthritis.
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To establish the diagnosis of dural penetration on preoperative computed tomographic studies of the cervical spine in patients with ossification of the posterior longitudinal ligament (OPLL). ⋯ The double-layer computed tomographic sign is more pathognomonic for dural penetration than the single-layer sign. The smooth-layer sign, indicating a clean dural plane, is more typical in North American patients.
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A biomechanical study was designed to assess relative rigidity provided by anterior, posterior, or combined cervical fixation using cadaveric cervical spine models for flexion-distraction injury and burst fracture. ⋯ This study showed that the posterior plating with interbody grafting is biomechanically superior to anterior plating with locked fixation screws for stabilizing the one-level flexion-distraction injury or burst injury. More rigid postoperative external orthoses should be considered if the anterior plating is used alone for the treatment of unstable cervical injuries. It was also found that combined anterior and posterior fixation may not improve the stability significantly as compared with posterior grafting with lateral mass screws and interbody grafting.
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A longitudinal study using patient questionnaires was performed. ⋯ The two specific instruments are capable of greater levels of discrimination between groups of patients, and are more responsive over time than the generic EuroQol. The Aberdeen instrument performed most satisfactorily in relation to these criteria, but the Roland instrument was more sensitive to differences between the two groups in the clinical trial. The measurement properties of these two instruments reflect their origin: The Aberdeen instrument is based on clinical questions, whereas the Roland instrument is based on the generic Sickness Impact Profile. Instrument content should be carefullyconsidered when selecting instruments for applications, including clinical trials.