Spine
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Comparative Study
The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain.
A retrospective case-control comparison between the Soft Tissue Stablization System according to Graf and instrumented posterolateral fusion in a consecutive series of patients operated on by a single surgeon. ⋯ Outcome after Soft Tissue Stabilization was associated with a worse outcome at 1 year and a significantly higher revision rate at 2 years. Revision was associated with a poor outcome similar to that seen in revision after fusion.
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In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed. ⋯ Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.
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One shortcoming of clinical practice guidelines is that generic, one-for-all guideline recommendations do not account for differences among patients' views about the desirability (or undesirability) of specific health outcomes, such as low back pain. Because differences in patients' preferences may lead to differences in the preferred therapy, a clinical practice guideline that does not consider patients' preferences may provide recommendations that are not optimal. Recently developed methodologic approaches enable guideline developers to assess the role of patients' preferences in clinical decisions and guideline recommendations, and to develop preference-based guidelines. ⋯ These options range from informal discussions with patients to computer-based utility assessments. Patients' preferences are an important factor in clinical decisions regarding management of low-back pain, particularly in decisions about surgical management and symptom control. Although further research is needed to define the role of techniques for assessing patients' preferences in routine clinical practice, guideline developers can determine when patients' preferences should play a prominent role in guideline recommendations.
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This prospective study includes normal control subjects and patients with focal lesions of the spinal cord investigated by transcranial magnetic stimulation. ⋯ The paravertebral myotomal-evoked potentials obtained by surface electrode from paravertebral muscles and by midline needle electrode in the intrinsic rotatory muscles of the spine were useful in localizing lesions in the spinal segments in most of the patients with thoracic-lumbar cord lesions.
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A report of two cases of severe sacroiliac pain that were resistant to conventional management techniques. Both patients had undergone lumbar fusion. This appeared to be a predisposing factor. ⋯ Two cases of refractory sacroiliac joint pain are reported that were managed with permanently implanted neuroprostheses at the third sacral nerve roots. The authors suggest that neuroaugmentation can be a reasonable option in selected patients with refractory sacroiliac pain.