Spine
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Reliability study of computed tomography imaging in 12 cadaver specimens instrumented with titanium or stainless steel thoracic pedicle screws. ⋯ Our data show that interobserver agreement is moderate and intraobserver agreement is substantial when computed tomography is used to assess placement of thoracic pedicle screws. We conclude that computed tomography is reliable for evaluating thoracic pedicle screw placement throughout the thoracic spine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Aprotinin reduces blood loss during spinal surgery in children.
A prospective blinded, randomized controlled study compared the effect of a perioperative infusion of aprotinin versus placebo during long segment spinal fusions in children. ⋯ This randomized, blinded study suggests that aprotinin significantly decreased blood loss and transfusion requirements in pediatric and adolescent scoliosis surgical patients at increased risk for intraoperative bleeding.
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This prospective cohort study evaluated four office tests of quadriceps strength in symptomatic adults with radiographic evidence of L3 or L4 nerve root compression. ⋯ In L3 and L4 radiculopathies, unilateral quadriceps weakness was best detected by a single leg sit-to-stand test. Patients of similar age with radicular pain caused by L5 or S1 radiculopathies could perform this test. As the interrater reliability of the single leg sit-to-stand test is high, clinicians should consider utilizing this test for assessing quadriceps strength in cases of L3 and L4 radiculopathies.
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A literature review was conducted to integrate and compile available reports on postoperative C5 palsy. ⋯ The incidence of postoperative C5 palsy has been reported at 4.6% after surgery for cervical compression myelopathy and this value has not varied with different surgical procedures or disease etiologies. The pathogenesis of postoperative C5 palsy remains unclear at the present time. Patients with postoperative C5 palsy generally have a good prognosis for functional recovery, but the severely paralyzed cases required significantly longer recovery times than the mild cases.
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Comment Letter Randomized Controlled Trial Clinical Trial
Re: Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 2002; 27:2193-204.