Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study.
A 3-year prospective randomized study was conducted. ⋯ The 3-year follow-up study did not show, on the average, that the surgery is superior to conservative treatment for mild and moderate forms of spondylotic cervical myelopathy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain.
Fifty-two practices in the East Midlands, United Kingdom, were included. ⋯ Radiography is likely to be cost-effective only when satisfaction is valued relatively highly. Strategies to enhance satisfaction for patients with low back pain without using lumbar radiography should be pursued.
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Clinical Trial
Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis.
Longitudinal radiographic measurements of the lumbar alignment in clinical cases were performed. ⋯ Degenerative lumbar scoliosis was triggered by any disc degeneration at the lumbar level. Loss of segmental lordosis usually occurs at the same disc level as segmental wedging. In the early phase of degenerative lumbar scoliosis, the scoliotic curvature not only progresses, but also may retrogress.
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Comparative Study Clinical Trial
Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography.
One hundred and three lumbar intervertebral discs (L3/4-L5/S1) of 36 patients with low back pain were examined with computed tomography (CT) diskography and magnetic resonance imaging (MRI). ⋯ This study showed a stronger association between endplate degeneration and disc degeneration than between endplate degeneration and disc rupture. The results indicate that the contrast injection during diskography reflects mainly pain of discogenic origin, whereas the possible pain associated with endplate damage cannot be depicted by CT diskography.
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This study correlates the mRNA and protein levels of large and small proteoglycans with the morphologic grade of degeneration. ⋯ Cells of the anulus fibrosus and nucleus pulposus react to tissue degeneration differently. Decreased mRNA expression by nucleus pulposus cells and declining protein content of the matrix make the nucleus more vulnerable to degeneration than the anulus. The cells in the anulus fibrosus respond to early degeneration by upregulating biosynthetic processes. However, in heavily degenerated tissues, the decline in the synthesis of aggrecan and the increase in the concentrations of small proteoglycans may be responsible for the failure of the repair processes.