Spine
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An original study was performed evaluating the information presented on existing web sites for the topic of lumbar disc herniation. ⋯ The quality of internet information on lumbar disc herniation is variable. Less than 10% of relevant web sites were determined to be of high-quality. The vast majority of sites were of poor informational value and more than one-third sought secondary commercialgain. The rank list of high quality sites generated from ourinformational quality score should prove useful to patients seeking information on the internet pertaining to lumbar disc herniation.
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A histological evaluation of biopsies obtained from presumed osteoporotic vertebral compression fractures (VCF) to confirm possible osteomalacia after tetracycline labeling. ⋯ The majority of biopsies from this series of patients revealed findings consistent with various stages of fracture healing. Osteoid seams were increased in 30 patients, representing either increased bone remodeling or osteomalacia. More cases with tetracycline labeling will help elucidate the true incidence of osteomalacia in this population. As we confirmed 4 cases of plasma cell dyscrasia, we advocate a biopsy during each first-time vertebral augmentation procedure.
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Subchondral mineralization of adjacent and transfixed facet joints was analyzed in patients with thoracolumbar spinal injuries, both before posterior instrumentation and after removal of the spinal implant. ⋯ Decrease in subchondral mineralization indicates reduced load acting on the examined zygapophysial joints. This finding in patients with early follow-up CT seems to be caused by reduced activity in most of the patients until removal of the spinal implant. In patients with longer intervals between removal of the fixator and second CT, higher loads acting on the adjacent and bridged joints are shown morphologically. Whether or not these changes lead to spondylarthritis has to be studied in a long-term follow-up.
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A systematic review. ⋯ It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.
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Randomized Controlled Trial
Looking away from whiplash: effect of head rotation in rear impacts.
Twenty healthy volunteers in a laboratory were subjected to rear-end impacts 4.4, 7.9, 10.9, and 13.1 m/s acceleration, with head rotation to the right and left. ⋯ If the head is rotated out of neutral posture at the time of rear impact, the injury risk tends to be greater for the sternocleidomastoid muscle contralateral to the side of rotation. Measures to prevent whiplash injury may have to account for the asymmetric response because many victims of whiplash are expected to be looking to the left or right at the time of collision.