Spine
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The cost of chronic benign spinal pain is large and growing. The costs of interventional treatment for spinal pain were at a minimum of $13 billion (U. S. dollars) in 1990, and the costs are growing at least 7% per year. ⋯ Cost-minimization versus cost-effectiveness approaches are described. Spinal cord stimulation and intraspinal drug infusion systems are alternatives that can be justified on a cost basis. Cost minimization analysis suggests that epidural injections under fluoroscopy may not be justified by the current literature.
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A clinical prospective observational cohort study of 15 patients undergoing cervical intervertebral disc replacement. ⋯ Cervical intervertebral motion can be maintained with the new device, which is clinically stable. Meticulous attention must be paid to the surgical technique to maximize the chances of a good result. The pilot study was successful, although it has yet to be determined what conditions will benefit most from this technology.
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A cross-sectional study was conducted. ⋯ The inner transverse diameter of the lumbar pedicle, particularly in young children, is smaller than previously reported. Insertion of screws currently available commercially screws seems to be safe in the L4-L5 pedicles of children ages 5 to 8 years, and in the L3-L5 pedicles of older children. Custom-made screws might be considered for upper levels for safe application.
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A literature review and synthesis were performed. ⋯ Intraspinal medication delivery has become an effective technique for control of intractable pain in appropriately selected patients seen by spine surgeons.
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Comparative Study
Biomechanical testing of posterior atlantoaxial fixation techniques.
An in vitro biomechanical study of C1-C2 posterior fusion techniques was conducted using a cadaveric model. ⋯ The results clearly indicate the screw-rod system's equivalence in reducing relative atlantoaxial motion in a severely destabilized upper cervical spine, as compared with the transarticular screw-wiring construct. These findings mirror the previously reported clinical results attained using this new screw-rod construct. Thus, the decision to use either screw construct should be based on safety considerations rather than acute stability.