Spine
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study.
Randomized clinical trial. ⋯ Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care.
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Multicenter Study
Refinement of the SRS-22 Health-Related Quality of Life questionnaire Function domain.
Prospective observational case series. ⋯ With a minor revision of question 18 (related to going out) the internal consistency of the SRS-22 Function domain has been improved in idiopathic scoliosis patients < 18 years of age. Deletion of question 15 (related to financial considerations) has a variable, small effect depending on patient group. Retention of question 15 is recommended unless a cultural variable, such as differences in healthcare payment schemes, substantially lowers domain psychometric properties.
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Randomized Controlled Trial Multicenter Study
Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial.
Double-blinded randomized controlled trial. ⋯ Although an IV bolus of glucocorticoids provides a short-term improvement in leg pain in patients with acute discogenic sciatica, its effects are transient and have small magnitude.
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Multicenter Study Clinical Trial
Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis.
Prospective clinical study. ⋯ In elderly patients with spinal stenosis with degenerative spondylolisthesis, dynamic stabilization with the Dynesys system in addition to decompression leads to similar clinical results as seen in established protocols using decompression and fusion with pedicle screws. It maintains enough stability to prevent further progression of spondylolisthesis or instability. With the Dynesys system, no bone grafting is necessary, therefore, donor site morbidity can be avoided.
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Case Reports Multicenter Study
Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study.
A retrospective study was undertaken that evaluated the medical records and imaging studies of a subset of patients with spinal injury from large level I trauma centers. ⋯ This multicenter study establishes that missed spinal injuries resulting in a neurologic deficit continue to occur in major trauma centers despite the presence of experienced personnel and sophisticated imaging techniques. Older age, high impact accidents, and patients with insufficient imaging are at highest risk.