Spine
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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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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.
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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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Immunohistochemical study of elastic fibers in human intervertebral discs (IVD) collected at surgery from patients with scoliosis. ⋯ Our results reveal an abundant and organized network of elastic fibers in the adolescent (12 and 17-year-olds) human IVD, and suggest that elastic fiber network plays a significant biomechanical role. This network is sparse and disrupted in scoliotic discs, and could be involved in the progression of the spinal deformity.
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Prospective cohort study. ⋯ Principles of wide surgical resection, commonly applied in appendicular oncology, can and should be used for the treatment of primary bone tumors of the spine with anticipated acceptable morbidity and satisfactory survival.