Neurosurgery
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Outcome of lumbar disc herniation is often based on clinical scores and less frequently on the neurological examination. However, even when clinical outcome measures are favorable, patients may still experience motor or sensory impairment. ⋯ There seems to be no correlation between clinical results and neurological impairment when assessed by the VAS and ODI.
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Multicenter Study Clinical Trial
Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood. ⋯ The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
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Randomized Controlled Trial Comparative Study
A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy.
Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy. ⋯ In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.
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Randomized Controlled Trial
Evaluation of epidural analgesic paste components in lumbar decompressive surgery: a randomized double-blind controlled trial.
Adjuncts for pain management in lumbar decompressive surgery are needed to reduce narcotic consumption and promote early mobility. ⋯ An analgesic paste containing methylprednisolone acetate is effective at reducing postoperative pain after lumbar decompressive surgery. Mixing effective doses of morphine sulfate in the paste abrogates the expected analgesic effects of epidural morphine.