Spine
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A reliability study of the Modic classification. ⋯ We have shown that the classification is both reliable and reproducible. It is simple and easy to apply for observers of varying clinical experience. We therefore recommend its use in clinical research and practice.
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A literature review and the authors' clinical experience for the indication of fusion in the degenerative lumbar and cervical spine is provided. ⋯ Lumbar and cervical fusion in the degenerative spine is frequently performed. Certain criteria have been established when a fusion should be considered. However, even these are not universally accepted. Strict prospective studies are needed to determine when a fusion of the degenerative, cervical, and lumbar spine is indicated. Patients with severe radicular pain may be considered for surgery after a comprehensive trial of conservative management. Fusion is usually necessary after a cervical discectomy, especially when spondylosis or osteophytic compression is present. Lumbar fusion is rarely indicated for routine discectomy. In patients with mechanical back or neck pain, surgery should only be considered after conservative measures have been exhausted and a radiographic abnormality is present at the symptomatic level, perhaps with pain concordant with discographic findings. Careful patient selection is the key to obtaining favorable surgical outcomes. In many cases, the goal may be a return to functionality rather than achieving a completely asymptomatic state.
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Review article. ⋯ Preliminary clinical evidence suggests that minimally invasive lumbar fusion techniques will benefit patients with spinal disorders.
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Sequential study of magnetic resonance imaging (MRI) of the spine for assessing the level of termination of the conus medullaris (CMT) and thecal sac (TST). ⋯ The CMT and TST displayed a wide range of values in our study. We detected small but systematic influences of gender and age on CMT and of age on TST, as well as a positive correlation between CMT and TST. These effects are small in amplitude, but they met all the criteria for statistical significance and have practical value for clinicians, as well as theoretical value for the medical and biologic community.