Spine
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Occlusion of the infrarenal abdominal aorta was applied to adult rabbits, which induced spinal cord ischemia, followed by disocclusion and reperfusion. Cortical somatosensory- and motor-evoked potentials were monitored continuously up to 24 hours and correlated to hind limb motor and sensory status. ⋯ Reperfusion injuries to the spinal cord might occur in the rabbit model after disocclusion. Cortical somatosensory-evoked potentials seemed to be a very sensitive index for spinal cord ischemia, whereas motor-evoked potentials correlated well with the course of reperfusion injuries after disocclusion and reflected long-term follow-up hind limb motor function better than cortical somatosensory-evoked potentials.
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Clinical Trial
Prediction of success from a multidisciplinary treatment program for chronic low back pain.
The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support. Initial evaluations included a medical examination, rating of the physical impairment, a personal interview, a visual analogue scale to record pain intensity, an assessment of limitations for daily activities, a pain disability index, a depression and psychovegetative scale, and a scale to evaluate general living standards. The physical assessment included different flexibility measurements, measurement of power and endurance through standardized exercises, and measurements of isokinetic trunk and lifting strength and general endurance. The measurements were repeated at the end of the 8-week program and thereafter an intervals of 6 and 12 months. Final analyses were carried out on 82 patients. ⋯ This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients.
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This study was designed to examine the possibility of a new spinal cord monitoring method using measurement of the refractory period to monitor spinal cord function. ⋯ The change of the responses elicited by the paired stimuli is more sensitive than those elicited by the single stimulus in the spinal cord evoked potentials. The absolute refractory periods and the recovery rate during 50% attenuation of the precompression amplitude is the critical alarm level in spinal cord monitoring.
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Morphometric, radiographic, and computed tomographic evaluation of the pedicle of the first sacral vertebra was performed, and the pedicle's spatial relation with the posterior surface of the ilium was defined. ⋯ This study suggests that placement of one screw through the S1 pedicle into the vertebral body is safer, and routine placement of two sacral pedicular screws may be difficult. The optimal starting point for placement of single iliosacral screw is 3 to 3.5 cm anterior to the posterior border of the iliac bone in the sagittal plans, and 3.5 to 4 cm cephalad to the greater sciatic notch. The screw should be directed perpendicular to the outer surface of the table from this entry point. The safe length of the iliosacral pedicular screw is up to 80 mm.
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Comparative Study Clinical Trial Controlled Clinical Trial
Reduction of blood loss during spinal surgery by epidural blockade under normotensive general anesthesia.
This study consisted of a comparison of intraoperative blood loss during posterior spins surgery under normotensive general anesthesia with and without epidural blockade, and a hemodynamic study after epidural injection. ⋯ The epidural blockade reduces intraoperative bleeding, even under normotensive conditions, and it takes effect in the lumbar spine, but not in the upper thoracic or cervical spine. This effect appears to be due chiefly to venous hypotension in the lumbar spine, which may be created by sympathetic blockade, with arteriolar dilatation and venous pooling in the lower limbs and reactive vasoconstriction in the lumbar vertebrae.