Spine
-
A case report. ⋯ In conclusion, trauma in athletes can cause intradiscal hematoma, which probably is a new etiology for disc degeneration. Also that sudden onset of pain in the hip or the gluteal region may be caused by referred pain due to a disc lesion. Intradiscal hematoma can be visualized using MRI.
-
Retrospective cohort study using a nationally representative inpatient database. ⋯ Although the revision burden for TDR was significantly higher than fusion surgery, the TDR revision burden fell within the revision burden range of hip and knee replacement, which are generally considered successful and cost-effective procedures. Economically, the higher revision burden for TDRs was offset by lower costs for both the primary as well as the revision procedures relative to fusion.
-
Comparative Study
Biomechanical comparison of iliac screws versus interbody femoral ring allograft on lumbosacral kinematics and sacral screw strain.
This study evaluates the effect of iliac screw fixation versus interbody femoral ring allograft (FRA) on lumbosacral kinematics and sacral screw strain in long segment instrumentations. ⋯ Testing revealed decreasing lumbosacral ROM as instrumentation extended cephalad (P < 0.05). In axial rotation, ROM was markedly higher for the allograft group compared to pedicle screw and iliac screw groups with instrumentation to L4 (P < 0.05). In flexion/extension, length of instrumentation in each group correlated with ROM. As length of instrumentation increased, ROM decreased, particularly for the iliac screw group. In lateral bending, ROM decreased in all groups as instrumentation lengthened (P < 0.05). Strain on unprotected sacral screws increased in flexion, extension, and lateral bending as instrumentation extended to L3 (P < 0.05). Iliac screws reduced strain in constructs to L3 and above (P < 0.05). Allograft reduced strain when fixation reached L2, but was not as effective as iliac screws overall. Neither iliac screws nor allograft reduced strain in constructs terminating at L5 or L4. (P > 0.05) CONCLUSION.: For instrumented fusions extending above L3, sacral screws should be protected with supplemental iliac screws or FRA at L5-S1. Of the two, iliac screws appear more effective.
-
Original report. ⋯ The putative negative correlation between DOS and outcome was not observed under any analysis in our study. PLIF procured a rapid and sustained improvement in CLBP, even where the DOS was excessively prolonged; and even after having allowed for pain severity. Symptom chronicity, therefore, does not represent a poor prognostic indicator for CLBP outcome after PLIF: PLIF should be considered irrespective of DOS. Because DOS and pain severity are likely mediators of "central sensitization," the hypothesis that central sensitization may be prevalent in CLBP patients selected for PLIF is therefore questioned.