Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
The use of intrathecal morphine for analgesia after posterolateral lumbar fusion: a prospective, double-blind, randomized study.
A prospective, randomized, double-blind, placebo-controlled study was undertaken to evaluate the efficacy and safety of intrathecal morphine for postoperative analgesia after posterolateral lumbar fusion. ⋯ Intrathecal morphine can be safe and efficacious as an early postoperative analgesic after lumbar fusion when respiratory monitoring is used.
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A retrospective, follow-up study. ⋯ The results suggest that clear myelographic stenosis and no prior surgical intervention, no comorbidity of diabetes, no hip joint arthrosis, and no preoperative fracture of the lumbar spine are factors associated with a good outcome in surgical management of lumbar spinal stenosis.
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The use of epidural steroid injections to relieve sciatic pain from spinal stenosis is extremely variable and controversial. Drs. ⋯ Dr. Rydevik believes that epidural steroids might be considered as a nonsurgical alternative, especially in elderly patients where surgery carries greater risk.
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A prospective study of the accuracy of thoracic pedicle screw placement in patients with idiopathic scoliosis. ⋯ Pedicle or vertebral body cortical penetration occurred with 25% of the screws but with no neurologic compromise. Curve correction was slightly greater than with hooks, but not to a statistically significant extent.
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Longitudinal follow-up study of back surgery reoperations using an administrative database. ⋯ The incidence of reoperation after back surgery is independent of diagnosis and type of surgery performed. Despite different anatomic reasons for surgical intervention, the success of different types of surgery are not influenced by the factors identified in this study. More extensive surgery does not prevent nor predispose a patient to the need for further surgery.