Spine
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Comparative Study
It is easier to confuse a jury than convince a judge: the crisis in medical malpractice.
A study of cervical spine malpractice cases was conducted. Identifying tort reform models may help to resolve a crisis in medical malpractice. ⋯ To solve the medical malpractice crisis, Congress, the individual states, or both should adopt tort reform. Two tort reform models compensating injured patients and eliminating physician liability appear to be not only effective but also fair to all concerned parties.
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Randomized Controlled Trial Comparative Study Clinical Trial
Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.
Randomized clinical trial. ⋯ The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
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Experimental investigation of the electrical conductivity of normal and trypsin-treated lumbar anulus fibrosis specimens. ⋯ Measured electrical conductivity was sensitive to tissue porosity, but not to fixed charged density for anulus fibrosis specimens in phosphate-buffered saline.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2.
A prospective, nonblinded, multicenter study of outcomes in patients undergoing single-level anterior lumbar discectomy and interbody fusion with InFUSE Bone Graft. ⋯ The use of InFUSE Bone Graft is a promising method of facilitating anterior intervertebral spinal fusion, decreasing pain, and improving clinical outcomes in patients who have undergone anterior lumbar fusion surgery with structural threaded cortical allograft bone dowels.
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Comparative Study
Biomechanical comparison of lumbosacral fixation techniques in a calf spine model.
biomechanical testing of the strength and stability of lumbosacral fixation constructs. ⋯ This study demonstrates the effectiveness of adding a second fixation point distal to the S1 screws in reducing S1 screw strain. Iliac fixation is more effective than secondary sacral fixation points but may not be necessary in all clinical situations. Only iliac fixation effectively increased the load to failure under catastrophic loading conditions. Supplementary sacral fixation failed to significantly protect against catastrophic failure. These findings support the clinical observation that iliac fixation is least likely to fail in high-risk, long fusions. Whether testing range of motion, screw strain, or load to failure, no benefit could be demonstrated for intrasacral rod placement when compared with other supplementary sacral fixation techniques. Intrasacral rod placement was equal to a second sacral screw in reducing S1 screw strain during flexion-extension loading. It was not as effective as iliac fixation in reducing screw strain or preventing catastrophic failure. When choosing fixation methods in long fusions to the sacrum, this study supports the use of iliac fixation as the method least likely to loosen or pull out. A second point of sacral fixation also offers biomechanical advantages when compared with S1 fixation alone and may be an appropriate choice in less "high risk" fusions to the sacrum.