Spine
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Survey-based descriptive study. ⋯ Variations in surgical procedures for cervical degenerative disease may depend on the clinical condition. Although this study found strong agreement in treatment approach to single-level disc herniation, significant variation was seen for the other degenerative conditions of the cervical spine. While differences in recommendation for fusion were not clearly associated with surgeon age, there was a trend toward the higher use of instrumentation by younger surgeons. Previously documented geographic variation may result in part from a lack of consensus regarding appropriate treatment techniques for certain degenerative conditions of the cervical spine, as well as surgeon-specific factors.
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Review Case Reports
Reduction of severe adolescent isthmic spondylolisthesis: a new technique.
The case of a 14-year-old boy with a severe-grade isthmic spondylolisthesis who underwent reduction and stabilization using this technique is described. ⋯ In severe-grade lumbosacral spondylolisthesis, isolated posterior fusion, even when supplemented with internal fixation, is not sufficient to prevent deformity progression. Therefore, a combined anterior and posterior fusion is necessary. Reduction of the deformity leads to restoration of normal sagittal alignment with an excellent cosmetic result. Reduction without release of posterior structures may lead to neurologic deficit. This 3-stage shortening procedure can provide sudden reduction of deformity with minimal risk of neurologic deficit. The procedure is technically demanding, and should be performed by spinal surgeons who are familiar with the principles of anterior and posterior fusions.
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A systematic review within the Cochrane Collaboration Back Review Group. ⋯ There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain and improve function and return-to-work status, in the short- and intermediate-term, compared with exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodologic quality and clinical relevance and evaluate the cost-effectiveness of back schools.
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Comparative Study
A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis.
A semi-prospective clinical study was conducted. ⋯ The prognostic criteria using the total scores from our revised scoring system were useful for the pretreatment evaluation of metastatic spinal tumor prognosis irrespective of treatment modality or local extension of the lesion.
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Comparative Study
Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels.
Biomechanical laboratory study of human cadaveric spines. ⋯ Based on our findings, posterior fixation with a pedicle screw-rod construct is suggested for 1-level PLIF and TLIF, and is necessary to achieve stability after interbody fusion across 2 levels using either technique.