Spine
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Retrospective chart and radiologic analysis. ⋯ In patients without myelomeningocele or congenital scoliosis, but with Arnold-Chiari malformation and syringomyelia, suboccipital craniectomy gave the best chance for syrinx reduction and scoliosis improvement, particularly in children younger than 10 years. Syrinx shunting improved none of the scolioses. For syrinxes in patients with congenital scoliosis or myelomeningocele, neither neurosurgical procedure resulted in curve improvement, as other causes of scoliosis (vertebra anomalies, paralysis) remained untreated. Patients with myelomeningocele require a multipronged surgical approach to address all causes of syrinx, thus minimizing the potential need for repeat neurosurgery. Scoliosis correction without prior syrinx decompression carries a high neurologic risk.
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Lateral radiographs of the lumbar spine were taken of 40 patients with lumbar spondylolisthesis. These radiographs were taken in the neutral, flexion, and extension positions for both erect and recumbent postures, and also in the prone and supine positions with traction applied via a traction table. ⋯ Erect flexion and prone traction radiographs represent the extremes of subluxation and reduction of the olisthesis, respectively, and the change in olisthesis seen between these extremes is correlated with the change in disc area and the intervertebral slip angle. Vertical laxity of the affected functional spinal unit resulting from disc degeneration produces laxity in the ligaments and disc anulus, allowing olisthetic motion. Restoration of disc height in turn restores tension to the soft tissues around the disc and results in a spontaneous reduction of the subluxation. Restoration and maintenance of disc height with a spacer or interbody fusion therefore is recommended as a goal in the treatment of spondylolisthesis. When spondylolytic spondylolisthesis involves a posterior column deficiency, additional reconstruction of this column with posterior instrumentation is recommended. Application of the traction radiographic technique in planning for spondylolisthesis reduction is discussed along with the technique of stabilization.
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Case Reports
Concomitant spine infection with mycobacterium tuberculosis and pyogenic bacteria: case report.
A case report of an extremely rare condition describing lumbar spine tuberculosis associated with concurrent pyogenic infection is presented. ⋯ It is concluded from this case that recovery of pyogenic bacteria from an infected spine does not exclude spine tuberculosis. It is recommended, therefore, that mycobacterial investigations be performed for cases that have evidence of tuberculosis, even when pyogenic microorganisms already have been isolated. The clues that raise suspicion of tuberculosis in patients with pyogenic spine infection include chronic infection that does not respond to ordinary antibiotics, isolated pyogenic bacteria of low virulence, psoas muscle calcification, and immunosuppression.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion.
A prospective, randomized, double-blind clinical trial was conducted. ⋯ Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, although the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system.
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Clinical Trial Controlled Clinical Trial
Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain.
A follow-up study evaluating postural control, lumbar movement perception, and paraspinal muscle reflexes in disc herniation-related chronic low back pain (LBP) before and after discectomy. ⋯ The results demonstrate impaired lumbar proprioception and postural control in sciatica patients. During short-term follow-up after operative treatment, postural control does not seem to change, but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover.