Spine
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Retrospective review of the clinical course and cervical spine plain radiographs, computed tomography, and magnetic resonance imaging of 24 consecutive patients for a 2-year period with a unilateral lateral mass/facet fracture. ⋯ Plain radiographs of the cervical spine lack sensitivity to detect the presence of lateral mass/ facet fractures. The appearance of the fracture on computed tomography does not indicate instability. The degree of ligamentous injury at the level of the fracture demonstrated on magnetic resonance imaging correlates with instability in this series. Operative stabilization may be indicated for unilateral lateral mass fractures that present with a subluxation or that have injury to at least three of the following ligaments: the facet region, the interspinous ligament, the anterior longitudinal ligament, and the posterior longitudinal ligament. However, before a definitive management plan can be formulated, results from this small series require further validation.
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A retrospective study of 16 patients who underwent the modified Robinson anterior cervical discectomy and fusion at three operative levels. ⋯ A three-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. Although not all pseudarthroses are painful, these data suggest that those with a successful fusion have a better outcome. It is recommended that these patients undergo additional or alternative measures to achieve arthrodesis consistently.
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Case Reports
Continuous electromyographic monitoring to detect nerve root injury during thoracolumbar scoliosis surgery.
The results of intraoperative monitoring during a case of nerve root injury sustained from scoliosis surgery to the thoracolumbar spine are described. ⋯ The authors of this study recommend electromyographic monitoring of appropriate lumbosacral myotomes in addition to somatosensory-evoked potentials during this type of procedure.
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Prevalence rates of childhood abuse, socioeconomic outcome data, and levels of psychopathology were evaluated for graduates of a functional restoration program for chronically disabled spinal disorder patients in a workers' compensation environment. ⋯ These results demonstrate that although a history of childhood abuse is associated with greater psychosocial disturbances in chronically disabled spinal disorder patients, such disturbances do not interfere with an initial positive response to an effective tertiary rehabilitation program such as functional restoration. However, a history of childhood abuse may be related to poorer socioeconomic outcomes after discharge from rehabilitation programs. Additional treatment options may be needed for these patients.