Spine
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Two cases are described in which displaced sternal fractures were associated with thoracic spine fractures of minimal, initial displacement. Nonoperative, expectant treatment led to significant kyphotic deformity. It is postulated that the sternum and ribs represent a fourth column of structural thoracic spine support. An overriding, displaced sternal fracture is a marker for a severe flexion-distraction unstable thoracic spine injury with a propensity for deformity.
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Comparative Study
The pain drawing and Waddell's nonorganic physical signs in chronic low-back pain.
Pain drawings were obtained from a group of 651 patients who had chronic low-back pain. Pain drawings were rated in four grades according to the degree of organic and nonorganic pain. Experienced and inexperienced evaluators were used. ⋯ A correlation between pain drawings and Waddell's nonorganic physical signs demonstrated that a large proportion of patients with high Waddell scores had nonorganic pain drawings. No significant differences were noted in the distribution of Waddell scores and pain drawings based on patient gender or payment status (i.e., medicolegal or workers' compensation). Pain drawings afford an important adjunct in the physician's assessment of chronic low-back pain.
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Knowledge of pedicle diameter and surface landmarks is crucial for safe placement of screws. Little attention has been paid to variations of entrance points for pedicle screws, differentiation of male and female pedicle sizes and pedicle size differences in nonwhite populations. Forty thoracolumbar spinal columns from T9 to L5 were measured using vernier calipers. ⋯ Starting points were parallel to the middle or lateral third of the superior facet joint at T9. At L5 starting points were at least one third of the facet joint lateral to the lateral border of the facet. Female pedicle width was smaller than male at T9 (P = 0.03) and T12 (P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
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The purpose of this study was to identify Sickness Impact Profile (SIP) items that are most sensitive to change in patients with low-back pain. Seventy-six patients with low-back pain were administered the SIP at their initial visit and after discharge from physiotherapy treatment. A formal item reduction was performed to identify the most sensitive items. ⋯ Twenty items were identified. Seven of the 20 items identified in this study appear on the Roland-Morris disability questionnaire. Also, only 50% of the items identified are from the physical subscale of the SIP.
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The purpose of the current study is to retrospectively review the incidence and types of complications occurring using a single pedicle screw fixation system for lumbar spine fusions. For a 3-year period beginning in July 1987, 470 patients underwent spinal fusion and instrumentation with the Wiltse Pedicle Screw Fixation System. Although multiple configurations of the Wiltse System were included, the predominant construct was that of segmental pedicle screw fixation. ⋯ There were three failures at the screw-bone interface, as well as four patients with uncoupling of the screw rod linkage. In addition, there were four broken rods encountered. A total of 122 Wiltse devices were removed, for an overall removal rate of 25%.(ABSTRACT TRUNCATED AT 250 WORDS)