Spine
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Fifteen specimens of the first cervical vertebra were tested by the application of pure tensile forces to failure. Seven specimens had intact transverse ligaments, and eight had transection of the transverse ligament before testing. Specimens were tested to failure by the rapid application of laterally directed tensile force to the ring; this force then was exerted through the lateral masses to simulate the mechanism of injury for this fracture as proposed by Jefferson. ⋯ The results of this study show that fractures of the C1 ring of greater than two parts can occur with pure tensile loading. The ring will fracture with as little as 1 mm of deformation.
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Randomized Controlled Trial Comparative Study Clinical Trial
One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.
A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. ⋯ Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.
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Fifty-seven patients with dens fractures were identified from 1986 to 1996 at the authors' institution. Forty-six were available for reevaluation by two independent observers with a mean follow-up period of 26 months. ⋯ Patients over 60 years of age with a dens fracture had a higher complication rate and lower cervical range of motion when treated conservatively with a halo. Final functional outcome and overall pain levels, however, did not differ significantly by age group or treatment modality.
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Population-based, cross-sectional, mailed survey. ⋯ Low-intensity/low-disability low back pain is a common problem in the general population. Approximately 11% of the adult population studied had been disabled by low back pain in the previous 6 months.
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Comparative Study
Dynamic motion study of the whole lumbar spine by videofluoroscopy.
Dynamic lumbar flexion-extension motion was assessed by videofluoroscopy. ⋯ Segmental instability influences the whole lumbar motion in patients with degenerative spondylolisthesis. The patients with chronic low back pain did not show a significant difference when compared with the volunteers.