Spine
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Randomized Controlled Trial Clinical Trial
1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study.
A prospective randomized clinical study. ⋯ Lumbar posterolateral fusion with pedicle screw fixation increases the operation time, blood loss, and reoperation rate, and leads to a significant risk of nerve injury. The functional outcome improves significantly with high patient satisfaction, with or without instrumentation. No significant differences were observed between the two groups in functional outcome and fusion rate. The only gain in functional outcome from instrumentation was found in the daily activity category in patients with supplementary neural decompression. The results of this study do not justify the general use of pedicle screw fixation alone as an adjunct to posterolateral lumbar fusion.
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A prospective and consecutive study of surgical results obtained during serial follow-up investigations in patients who underwent surgery for central lumbar spinal stenosis. ⋯ The results after surgical decompression in patients with central spinal stenosis deteriorated with time. There was a significant correlation between good result and pronounced constriction of the spinal canal. Patients with a preoperative duration of symptoms of less than 4 years and patients with no preoperative back pain tended to have better surgical outcomes. The reoperation rate was 18% within 5 years. When surgery for spinal stenosis is contemplated, these prognostic factors should be taken into consideration: The "ideal patient" has a pronounced constriction of the spinal canal, insignificant lower back pain, no concomitant disease affecting walking ability, and a symptom duration of less than 4 years.
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A biomechanical study of the compressive creep behavior of the porcine intervertebral disc before and after frozen storage. ⋯ In vitro tests of frozen porcine intervertebral discs do not represent fresh behavior. Frozen storage appears to permanently alter disc behavior. The precise nature of any freezing-induced damage, and whether frozen storage similarly affects human discs, remains to be seen.
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Twenty-four pigs were randomized into three groups of eight pigs; a control group with 0% stenosis, a 25% stenosis group, and a 50% stenosis group. A fourth 75% stenosis group was added when results of the randomized experiment had been analyzed. Blood flow of the spinal cord and nerve roots and spinal evoked potentials were determined before and 1 hour after induction of the spinal stenoses. ⋯ Blood supply of the spinal cord and nerve roots in the segments between two central stenoses is preserved immediately after stenosis introduction by way of the segmental nerve pathway, even if nerve conduction is impaired.
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Randomized Controlled Trial Comparative Study Clinical Trial
1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation.
This prospective study analyzed the influence of transpedicular instrumented on the operative treatment of patients with degenerative spondylolisthesis and spinal stenosis. ⋯ In patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws may lead to a higher fusion rate, but clinical outcome shows no improvement in pain in the back and lower limbs.