Spine
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Comparative Study Clinical Trial
Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy.
A retrospective and prospective study was conducted to investigate intraoperative neurophysiologic monitoring during cervical laminectomy to detect iatrogenic C5 nerve root palsy. ⋯ In an effort to reduce postoperative C5 nerve root palsy, the clinician should consider intraoperative deltoid and biceps transcranial electrical motor-evoked potential and spontaneous electromyography monitoring whenever there is potential for iatrogenic C5 nerve root injury.
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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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Comparative Study
Biomechanical testing of posterior atlantoaxial fixation techniques.
An in vitro biomechanical study of C1-C2 posterior fusion techniques was conducted using a cadaveric model. ⋯ The results clearly indicate the screw-rod system's equivalence in reducing relative atlantoaxial motion in a severely destabilized upper cervical spine, as compared with the transarticular screw-wiring construct. These findings mirror the previously reported clinical results attained using this new screw-rod construct. Thus, the decision to use either screw construct should be based on safety considerations rather than acute stability.
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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 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.