Spine
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Multicenter Study Comparative Study Clinical Trial
Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5.
A retrospective review of 42 patients treated at three major medical centers for burst fractures of L3, L4, and L5. This is the largest low lumbar (L3-L5) burst fracture study in the literature to date. The study was designed to assess both radiographic and clinical outcomes in a cohort of patients treated during a 16-year period. ⋯ The results of nonoperative treatment of low lumbar burst fractures were comparable with those of operative treatment. The rate of repeat surgery (41%) and absence of a clearly definable long-term functional or radiographic benefit in patients without neurologic compromise may make surgery less appealing.
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Multicenter Study
Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients.
An outcome questionnaire was constructed to evaluate patient satisfaction and performance and to discriminate among patients with adolescent idiopathic scoliosis. ⋯ This questionnaire addresses patient measures for evaluation of outcome in adolescent idiopathic scoliosis surgery by examining several domains. It also allows for dynamic monitoring of scoliosis patients as they become adults. This is a validated instrument with good reliability measures.
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Multicenter Study Comparative Study Clinical Trial
Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up.
A comparison of treatment of 412 patients with chronic back pain at two separate centers using the same treatment protocols and outcome measures. Outcome was defined by specific strength testing; Short Form-36 scores at intake, discharge, and 1-year follow-up; self-appraisal of improvement at discharge and in a 1-year follow-up; and reuse of health care services after discharge. ⋯ Standardized protocols using specific strength and measurement equipment can achieve similar benefits at different sites.
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Multicenter Study Comparative Study Clinical Trial
Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion.
Two hundred-forty consecutive patients underwent laparoscopic instrumented interbody fusion using custom-designed instrumentation and BAK (Sulzer Spine Tech, Minneapolis, MN) fusion cages. The surgeries were performed at eight spine centers during U.S. Food and Drug Administration investigational device evaluation clinical trials. This cohort was compared with 591 consecutive patients undergoing open anterior fusion with the same device. ⋯ The laparoscopic procedure is associated with a learning curve, but once mastered, it is effective and safe when compared with open techniques of fusion.
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Multicenter Study Comparative Study Clinical Trial
Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis.
This was a prospective study of two cohort groups of patients (one group receiving anterior instrumentation and the other posterior instrumentation) receiving treatment for thoracic idiopathic scoliosis. ⋯ 1) Coronal correction and balance were equal in both the anterior and posterior groups, even though the anterior group had the majority of curves (97%) fused short or to L1, whereas only 18% were fused short or to L1 in the posterior group. 2) In the anterior group there was a better correction of sagittal profile in those with a preoperative hypokyphosis less than 20 degrees. However, hyperkyphosis (with a mean of 54 degrees) occurred in 40% of those in the anterior group with a preoperative kyphosis of more than 20 degrees. 3) An average of 2.5 lumbar levels can be saved with anterior fusion and instrumentation according to the criteria used for choosing posterior fusion levels in this study. 4) Using the 3.2-mm flexible rod in this study, loss of correction, pseudarthrosis, and rod breakage were unacceptably highe