European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Meta Analysis
A systematic review of paracetamol for non-specific low back pain.
The objective of this study was to assess the efficacy of paracetamol (acetaminophen) in the treatment of pain and disability in patients with non-specific low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of paracetamol in the treatment of pain and disability in patients with non-specific low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. ⋯ No trial reported a statistically significant difference in favor of paracetamol. There is insufficient evidence to assess the efficacy of paracetamol in patients with low back pain. There is a clear need for large, high quality randomized controlled trials evaluating paracetamol, to provide reliable evidence of paracetamol's effectiveness in patients with low back pain and to establish the validity of the recommendations in clinical guidelines.
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Segmental pedicle screw fixation is rapidly becoming a popular method of spinal instrumentation. Few studies have investigated the rates of adjacent superior segment facet joint violation. The purpose of our study were to investigate the incidence of superior segment facet joint violation after pedicle screw instrumentation in the lumbar spine and to evaluate technical factors related to the incidence. ⋯ The spinal research fellow noted the incidence of facet joint violation to be present in 23.8% of the screws and 32.9% of the patients in Group 2, whereas the consultant radiologist noted this to be the case in 25.2 and 35.5%, respectively. The incidence of facet joint violation in patients with CD-Horizon screws was far lower than patients with TSRH screws (P < 0.001). In conclusion, it seems that meticulous surgical dissection without injuring the top-level facet joints, proper instrumentation of pedicle screws with the appropriate entry site (Weinstein's method), trajectory, and use of top-loading screw heads are some ways that surgeons could minimize the risk of top-level facet joint violation.
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Postoperative delirium and its risk factors had been widely reported in several kinds of surgeries; however, there is only one known article relative to postoperative delirium in spinal surgery. We retrospectively examined the incidence of postoperative delirium and the probable risk factors in patients undergoing spinal surgery in our hospital, with the same aged non-delirium patients as controls, over a 6-month period. Studies about postoperative delirium were reviewed and referenced for variable factors collecting in our study. ⋯ Our findings suggest that postoperative delirium in spinal surgery can also occurred in younger patients and with an acceptable incidence in total. The risk for postoperative delirium is multifactorial. More prospective research is necessary in order to evaluate these and other risk factors in greater detail.
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Comparative Study
Assessment of different screw augmentation techniques and screw designs in osteoporotic spines.
This is an experimental study on human cadaver spines. The objective of this study is to compare the pullout forces between three screw augmentation methods and two different screw designs. Surgical interventions of patients with osteoporosis increase following the epidemiological development. ⋯ The perforated screw design led to epidural leakage due to the position of the perforation in the screw. The position of the most proximal perforation is critical, depending on screw design and proper insertion depth. Nevertheless, using a properly designed perforated screw will facilitate augmentation and instrumentation in osteoporotic spines.
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This study investigated the effect of endplate deformity after an osteoporotic vertebral fracture in increasing the risk for adjacent vertebral fractures. Eight human lower thoracic or thoracolumbar specimens, each consisting of five vertebrae were used. To selectively fracture one of the endplates of the middle VB of each specimen a void was created under the target endplate and the specimen was flexed and compressed until failure. ⋯ Subsequent flexion with compression to failure resulted in adjacent fracture close to the fractured endplate in six specimens and in a non-adjacent fracture in one specimen, while one specimen had no adjacent fractures. Depression of the fractured endplate alters the pressure profile of the damaged disc resulting in increased compressive loading of the anterior wall of adjacent vertebra that predisposes it to wedge fracture. This data suggests that correction of endplate deformity may play a role in reducing the risk of adjacent fractures.