Spine
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The authors performed a correlative macroscopic, histologic, and immunohistochemical investigation on human lumbar intervertebral discs using complete motion segment slices, including all age groups and stages of degeneration. ⋯ The authors present the first study in which age-related changes are correlated on a macroscopic, histologic, and molecular level using complete sections of lumbar motion segments. They reconfirm the notion that disc degeneration starts as early as in the second decade of life. Therefore, only early prevention of disc damage may inhibit disc degeneration and its sequelae. Phenotypic alterations of nuclear chondrocytes as monitored by collagen Type IV in young adults with minor lesions and collagen Type X in advanced lesions indicate distinct cellular reactions, possibly as a reaction to enhanced oxidative stress. The degree of this oxidative stress is reflected by the CML-staining pattern which, in turn, indicates that the disc undergoes an accumulative stress, possibly leading to altered properties of the collagen fibrils and, thereby, tissue destruction. The deposition of CML proved to be the best marker for ongoing age-related changes in the intervertebral disc.
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A prospective study of consecutive patients undergoing surgery for central lumbar spinal stenosis. ⋯ Pain was more intense and positive straight leg raising test results were more common in younger patients, whereas reflex disturbances were more common in the elderly. The vertebral site for the lowest anteroposterior value was higher with higher age. Preoperative duration did not affect the severity of symptoms or signs. Patients with more pronounced stenosis tended to have a more severe reduction of walking ability. There was no correlation between symptoms and signs and radiographically detected constriction.
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A retrospective review of the case records and radiographs of 133 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation between 1986 and 1992. ⋯ Performance of a thoracoplasty was the only risk factor for postoperative pulmonary complications in patients undergoing posterior spinal fusion. There was no correlation between deterioration of preoperative pulmonary function and the risk of postoperative pulmonary complications. It appears that performance of preoperative pulmonary function tests in patients with moderate adolescent idiopathic scoliosis-scheduled for posterior spinal fusion is not necessary.
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Biomechanical testing with human cadaveric lumbar vertebral bodies was used to determine the utility of an injectable carbonated apatite cancellous bone cement for improving the structural performance of pedicle screws subjected to axial pull-out or transverse cyclic loading. ⋯ The data suggest that augmentation with this carbonated apatite cancellous bone cement can enhance immediate screw fixation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of traction for nonspecific low back pain. 12-week and 6-month results of a randomized clinical trial.
A randomized clinical trial. ⋯ Most common flaws of earlier studies on traction therapy could be overcome. This trial did not support the claim that traction is efficacious for patients with low back pain.