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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Review article. ⋯ Preliminary clinical evidence suggests that minimally invasive lumbar fusion techniques will benefit patients with spinal disorders.
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Review Case Reports
Sacral insufficiency fractures following multilevel instrumented spinal fusion: case report.
Case series. ⋯ Patients who complain of new-onset buttock pain following multilevel lumbar-sacral fusion with instrumentation should be evaluated for sacral insufficiency fractures, especially if they have been sitting for prolonged periods. Conservative treatment seems to be sufficient.
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Review Case Reports
Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report.
Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain. ⋯ From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.