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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This prospective demographic study was undertaken to review the epidemiology and demographics of all acute admissions to the National Spinal Injuries Unit in Ireland for the 5 years to 2003. The study was conducted at the National Spinal Injuries Unit, Mater Miscericordiae University Hospital, Dublin, Ireland. Records of all patients admitted to our unit from 1999 to 2003 were compiled from a prospective computerized spinal database. ⋯ The cervical spine was most commonly affected (51%), followed by lumbar (28%) and thoracic (21%). On admission 38% of patients were ASIA D or worse, of which one-third were AISA A. Understanding of the demographics of spinal column injuries in unique populations can help us to develop preventative and treatment strategies at both national and international levels.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial.
A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. ⋯ The results demonstrate that a shorter operation duration and concomitant quicker recovery is comprehensible at an experienced minimally invasively operating centre. These advantages could not be found at the transfer centre within 25 minimally invasive procedures. In conclusion both procedures show equal mid term clinical results and the same complication rate even if the suggested advantages for the minimally invasive procedure could not be confirmed for the transfer centre within the framework of this study.
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Review Case Reports
Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis.
The case of an upper oesophageal perforation as a concomitant injury of an isolated fracture of the upper thoracic spine without neurological compromise has not been described so far. A Case report and review of the literature is presented here. Concomitant oesophageal perforations carry a high risk of being missed initially. ⋯ There are no systematic data on thoracic spine fractures with concomitant oesophageal perforations. Mediastinitis secondary to oesophageal perforation might be treated conservatively with endoscopic stent placement rather than surgically. As the radiological signs of concomitant soft tissue injury, like oesophageal perforations, in fractures of the upper thoracic spine are subtle and easily missed initially only anticipation of concomitant injuries by the treating physician based on the trauma mechanism ensures a timely diagnosis.
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Randomized Controlled Trial
Psychosocial education improves low back pain beliefs: results from a cluster randomized clinical trial (NCT00373009) in a primary prevention setting.
The general population has a pessimistic view of low back pain (LBP), and evidence-based information has been used to positively influence LBP beliefs in previously reported mass media studies. However, there is a lack of randomized trials investigating whether LBP beliefs can be modified in primary prevention settings. This cluster randomized clinical trial investigated the effect of an evidence-based psychosocial educational program (PSEP) on LBP beliefs for soldiers completing military training. ⋯ Sensitivity analyses suggested minimal influence of drop out. In conclusion, soldiers that received the PSEP had an improvement in their beliefs related to the inevitable consequences of and ability to cope with LBP. This is the first randomized trial to show positive influence on LBP beliefs in a primary prevention setting, and these findings have potentially important public health implications for prevention of LBP.
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To investigation of the outcomes of indirect posterior decompression with corrective fusion for myelopathy associated with thoracic ossification of the longitudinal ligament, and prognostic factors. Conservative treatment for myelopathy associated with thoracic ossification of the longitudinal ligament (OPLL) is mostly ineffective, and treatment is necessary. However, many authors have reported poor surgical outcomes, and no standard surgical procedure has been established. ⋯ We consider that additional application of anterior decompressive fusion is preferable when improvement of symptoms occurs not satisfactory after indirect posterior decompression with corrective fusion using instruments. Intraoperative spinal cord monitoring of CMAP demonstrated that the spinal cord was already impaired during the laminectomy via the posterior approach. Concomitant intraoperative monitoring of CMAP to avoid impairment of the vulnerable spinal cord and corrective posterior spinal fusion with indirect spinal cord decompression is recommendable as a method capable of preventing postoperative neurological aggravation.