Spine
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Randomized Controlled Trial
ISSLS prize winner: cost-effectiveness of two forms of circumferential lumbar fusion: a prospective randomized controlled trial.
Economic evaluation alongside a prospective, randomized controlled trial from a secondary care National Health Service (NHS) perspective. ⋯ From an NHS perspective, the trial data show that TC is not cost-effective in circumferential lumbar fusion. The use of FRA was both cheaper and generated greater QALY gains. In addition, FRA patients reported a greater return to work rate.
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Systematic Review. ⋯ Pain has a central role to play as a prognostic factor for the development of LWS. Other physical factors commonly used in the clinical setting showed inconclusive evidence for their influence on prognosis. There is a need for improved quality of studies with consistent use of validated measures of all categories of prognostic factors and outcome. This may then provide a clearer understanding of prognosis of Whiplash Associated Disorders and therefore facilitate effective management of this costly problem.
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Human nucleus pulposus cells were cultured in alginate beads and activated with IL-1 beta or TNF-alpha, with and without inhibition of p38 mitogen activated protein kinase (p38 MAPK) activity. Cell production of factors modulating the anabolic/catabolic balance of the disc was determined. ⋯ Inhibition of p38 MAPK in cytokine-activated disc cells blunts production of factors associated with inflammation, pain, and disc matrix catabolism. The data support further analysis of these effects on the anabolic/catabolic balance of nucleus pulposus cells and suggest that molecular techniques blocking this signal could provide a therapeutic approach to slow the course of intervertebral disc degeneration.
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Comparative Study
Training and evaluating spinal surgeons: the development of novel performance measures.
Cohort study. ⋯ Four variables, 3 involving process measures and 1 an outcome measure, can be used to distinguish between novice and expert spine surgeons using a simple lumbar spine pedicle cannulation task, providing evidence of their construct validity. Knowledge of these differences may be useful in objective evaluation of surgical competence and providing precise feedback during the training of this skill, thereby enhancing learning.
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Comparative Study
Comparative charge analysis of one- and two-level lumbar total disc arthroplasty versus circumferential lumbar fusion.
This is a retrospective, independent study comparing 2 groups of patients treated surgically for discogenic low back pain associated with degenerative disc disease (DDD) in the lumbosacral spine. ⋯ Patients undergoing 1- and 2-level ProDisc total disc replacement spent significantly less time in the OR and had less EBL than controls. Charges were significantly lower for TDR compared with circumferential fusions in the 1-level patient group, while charges were similar in the 2-level group.