Spine
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Retrospective study to gather long-term data clinical, paraclinical, and radiographic data on nonoperatively managed cases of childhood spondylodiscitis. ⋯ Our study shows that the course of childhood spondylodiscitis is generally benign. Segmental orbony ankylosis may occur during the healing process but normally does not lead to serious functional deficits. Neurologic deficits were not observed in any of our patients. Conservative management must be intensive, but the results are good. Biopsy is not required except in the few cases where diagnostic uncertainty prevails.
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Comparative Study
Reliability of retrospective clinical data to evaluate the effectiveness of lumbar fusion in chronic low back pain.
Patients in whom a posterior spinal fusion instrumentation had been performed to treat low back pain were asked to recall their preoperative clinical status by retrospectively filling out the same 3 self-evaluation scales they had completed before surgery in a prospective fashion. ⋯ Relying on a patient's recall of preoperative clinical status is not an accurate method to evaluate surgical outcome after posterior spinal fusion instrumentation. Cross-sectional studies may overestimate the effectiveness of surgery.
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Comparative Study
Biomechanical comparison of anterior versus posterior lumbar threaded interbody fusion cages.
Biomechanical flexibility tests were performed in specimens receiving anterior lumbar interbody fixation or posterior lumbar interbody fixation using dual threaded cages. ⋯ Both anterior lumbar interbody fixation and posterior lumbar interbody fixation provided inconsistent stability. Therefore, stand-alone anterior lumbar interbody fixation or posterior lumbar interbody fixation may often be ineffective clinically. During all modes of loading except axial rotation, posterior lumbar interbody fixation performed slightly better than anterior lumbar interbody fixation, perhaps due to deeper hole preparation and destruction of anterior stabilizers necessary for anterior lumbar interbody fixation. Avoiding resection of facets during posterior lumbar interbody fixation led to significantly better performance during axial rotation.
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Multicenter Study
Differences in the work-up and treatment of conditions associated with low back pain by patient gender and ethnic background.
Retrospective review comparing physician workup of degenerative lumbosacral pathologies between different genders and ethnic groups. ⋯ This study suggests that ethnicity and gender affect the workup and surgical management of degenerative spinal disorders. However, it should be noted that there are a number of confounding factors not identified in the database, including managed care and insurance status and cultural differences, which may affect both test ordering and treatment recommendations. Further study of bias in clinical decision-making is indicated to assure equal delivery of quality care.
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The Load Sharing Classification of spinal fractures was evaluated by 5 observers on 2 occasions. ⋯ Kappa statistics showed high levels of agreement when the Load Sharing Classification was used to assess thoracolumbar burst fractures. This system can be applied with excellent reliability.