Spine
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Randomized Controlled Trial Comparative Study
Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2/compression resistant matrix versus iliac crest bone graft.
This is a prospective, randomized study comparing iliac crest bone graft to bone morphogenetic protein (BMP)/compression resistant matrix in instrumented posterolateral fusions for single-level lumbar degenerative disease. A higher recombinant human bone morphogenetic protein (rhBMP)-2 dose and a carrier specific for posterior spine applications were used. ⋯ There was significant improvement of Short Form 36 (physical component score and pain), Oswestry Low Back Pain Disability Index, and leg and back pain scores in both groups over all time intervals. Surgical time and blood loss were significantly less in the BMP/compression resistant matrix group. The fusion rate in the BMP/compression resistant matrix group was significantly higher than the iliac crest bone graft group.
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Retrospective review. ⋯ DTs are common during degenerative lumbar spine surgery. Revision surgery is twice as likely as primary surgery to result in this complication. Our postoperative early mobilization protocol appears to be an effective and safe management strategy for treating this complication (98.2% success rate). Very few patients (6 of 338, or 1.8%) needed a reoperation.
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A cross-sectional study to evaluate the long-term result of posterolateral (PLF), anterior (AF), and circumferential fusion (CF) for isthmic spondylolisthesis. ⋯ The clinical outcome was best in the CF group as measured by ODI. Degenerative changes were most commonly found at the level of the slip and above the fusion level. The prevalence of disc prolapses was low. Spinal fusion for isthmic spondylolysis is not associated with central canal stenosis above the fusion. Radiologic nerve root stenosis was common but asymptomatic. Mild muscle atrophy was common.
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Comparative Study
Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis.
A radiographic study of 82 patients with L5-S1 spondylolysis or spondylolisthesis of less than 50% displacement of L5 on S1. ⋯ These data suggest that differences in the sagittal alignment of the spine and pelvis may influence the biomechanical environment that results in the development of spondylolysis and progressive spondylolisthesis.
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain.
A prospective, randomized triple-blind clinical trial. ⋯ Intraoperative IV injection of 40 mg dexamethasone could effectively reduce postoperative radicular leg pain and narcotics usage in patients with single-level herniated lumbar disc.