Spine
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A literature review was conducted. ⋯ The ultimate efficacy of spinal cord stimulation remains to be determined, primarily because of limitations associated with the published literature. However, on the basis of the current evidence, it may represent a valuable treatment option, particularly for patients with chronic pain of predominantly neuropathic origin and topographical distribution involving the extremities. The potential treatment of other pain topographies and etiologies by spinal cord stimulation continues to be studied.
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The literature on diagnostic tests available to the spine clinician for the evaluation of chronic low back pain was reviewed. ⋯ There are inherent limitations in the accuracy of all diagnostic tests. The tests used to diagnose the source of a patient's chronic low back pain require accurate determination of the abolition or reproduction of the patient's painful symptoms.
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The cost of chronic benign spinal pain is large and growing. The costs of interventional treatment for spinal pain were at a minimum of $13 billion (U. S. dollars) in 1990, and the costs are growing at least 7% per year. ⋯ Cost-minimization versus cost-effectiveness approaches are described. Spinal cord stimulation and intraspinal drug infusion systems are alternatives that can be justified on a cost basis. Cost minimization analysis suggests that epidural injections under fluoroscopy may not be justified by the current literature.
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A clinical prospective observational cohort study of 15 patients undergoing cervical intervertebral disc replacement. ⋯ Cervical intervertebral motion can be maintained with the new device, which is clinically stable. Meticulous attention must be paid to the surgical technique to maximize the chances of a good result. The pilot study was successful, although it has yet to be determined what conditions will benefit most from this technology.
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A cross-sectional study was conducted. ⋯ The inner transverse diameter of the lumbar pedicle, particularly in young children, is smaller than previously reported. Insertion of screws currently available commercially screws seems to be safe in the L4-L5 pedicles of children ages 5 to 8 years, and in the L3-L5 pedicles of older children. Custom-made screws might be considered for upper levels for safe application.