Spine
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To examine changes in substance P receptors on dorsal root ganglion cells innervating the rat lumbar intervertebral discs using immunohistochemistry and a retrograde neurotracing method. ⋯ Substance P-saporin decreased the ratio of neurokinin-1 immunoreactive neurons innervating the disc related to discogenic low back pain. Substance P-saporin may be a useful tool to investigate the mechanism of discogenic low back pain.
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Comparative 3-dimensional biomechanical testing. ⋯ The iliosacral fixation with 2 6.5 mm AO-cancellous screws for complete sacroiliac dislocation demonstrated the highest stiffness and the short spinal instrumentation the poorest stiffness. All other fixation techniques could be generally considered of equivalent stability value.
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Comparative Study
MMPI disability profile: the least known, most useful screen for psychopathology in chronic occupational spinal disorders.
Prospective study on predicting psychopathology in chronic occupational spinal disorders (COSDs). ⋯ The prevalence of commonly cited MMPI profiles, often used for presurgical or chronic pain screening in this population, is relatively small. The prevalence of four or more elevations (DP), however, is large, representing two thirds of patients demonstrating any classifiable MMPI pattern. The DP group showed extremely high levels of associated psychopathology, which raises "red flags" to the surgeon likely to operate on such patients, or the interdisciplinary pain team. Screening COSD patients with the MMPI-2 may be effective in identifying psychopathology, but only if the physician is aware that the DP is commonplace and significant.
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Comparative Study
Is obesity overrated as a "risk factor" for poor outcomes in chronic occupational spinal disorders?
Prospective cohort study. ⋯ Obesity is more prevalent and severe in chronic occupational spinal disorders when entering a functional restoration program as the final step in a prolonged treatment regimen. We conclude that obesity, even gross obesity, has no significant impact on outcomes of an interdisciplinary functional restoration program for patients disabled an average of 16 months.
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Randomized Controlled Trial Comparative Study
Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial.
Prospective randomized clinical study with a 5- to 9-year follow-up period. ⋯ Circumferential lumbar fusion demands more extensive operative resources compared with posterolateral lumbar fusion. However, 5 to 9 years after surgery, the circumferentially fused patients had a significantly improved outcome compared with those treated by means of posterolateral fusion. These new results not only emphasize the superiority of circumferential fusion in the complex pathology of the lumbar spine but are also strongly supported in all of the validated questionnaires used in the study.