Spine
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A cross-sectional study. ⋯ When the appropriate technique is used, medial branch blocks are target specific. To guard against false-negative responses due to intravenous up-take, contrast medium must be used before the injection of local anaesthetic.
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Comparative Study Clinical Trial Controlled Clinical Trial
Reduction of blood loss during spinal surgery by epidural blockade under normotensive general anesthesia.
This study consisted of a comparison of intraoperative blood loss during posterior spins surgery under normotensive general anesthesia with and without epidural blockade, and a hemodynamic study after epidural injection. ⋯ The epidural blockade reduces intraoperative bleeding, even under normotensive conditions, and it takes effect in the lumbar spine, but not in the upper thoracic or cervical spine. This effect appears to be due chiefly to venous hypotension in the lumbar spine, which may be created by sympathetic blockade, with arteriolar dilatation and venous pooling in the lower limbs and reactive vasoconstriction in the lumbar vertebrae.
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Morphometric, radiographic, and computed tomographic evaluation of the pedicle of the first sacral vertebra was performed, and the pedicle's spatial relation with the posterior surface of the ilium was defined. ⋯ This study suggests that placement of one screw through the S1 pedicle into the vertebral body is safer, and routine placement of two sacral pedicular screws may be difficult. The optimal starting point for placement of single iliosacral screw is 3 to 3.5 cm anterior to the posterior border of the iliac bone in the sagittal plans, and 3.5 to 4 cm cephalad to the greater sciatic notch. The screw should be directed perpendicular to the outer surface of the table from this entry point. The safe length of the iliosacral pedicular screw is up to 80 mm.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Local and remote sustained trigger point therapy for exacerbations of chronic low back pain. A randomized, double-blind, controlled, multicenter trial.
A randomized, double-blind, controlled, multicenter trial was conducted. ⋯ Neuroreflexotherapy intervention seems to be a simple and effective treatment for rapid amelioration of pain episodes in patients with chronic low back pain. At this time, the duration of pain relief beyond 45 days has not been evaluated.
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Seventy-one patients with low back pain were examined by two physiotherapists (50 patients) and two physicians (21 patients). The two physiotherapists had worked together for many years, but the two physicians had not. The interexaminer reliability of the clinical tests included in the physical examination was evaluated. ⋯ On the basis of the physiotherapists series, the reliability was acceptable for a number of clinical tests that are used in the evaluation of patients with low back pain. The results suggest that clinical tests should be standardized to a much higher degree than they are today.