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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Gout is a common metabolic disease characterized by the development of arthritis and nephropathy related to the deposition of monosodium urate crystals within the joints, periarticular tissues, skin and kidneys. Tophus formation seen around the spinal column is very rare, while occurrences of spinal gout tophus without systemic gout disease are much more unique. In our study, we report a spinal gout case that presented with right sciatica without previous history of systemic gout disease.
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Case report. ⋯ In patients with lower back and leg pain, physicians should consider non-spinal conditions that can cause signs and symptoms mimicking lumbar radiculopathy.
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Case Reports
The use of intra-operative blood gas analysis in the investigation of suspected iatrogenic vascular injury.
Iatrogenic injury to the vertebral artery during posterior cervical fusion is a rare and potentially disastrous complication. Differentiating arterial from brisk venous bleeding would be ideal to assist in the intra-operative management. Definitive angiography is typically not feasible during most routine spine surgery. ⋯ Blood gas analysis can be a useful adjunct in determining the nature of hemorrhage from vascular structures in spine surgery when visual inspection is indeterminate.
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Comparative Study
An in vitro biomechanical comparison of Cadisc™-L with natural lumbar discs in axial compression and sagittal flexion.
The elastomeric, monobloc disc prosthesis (Cadisc™-L, Ranier Technology, Cambridge, UK) aims to preserve biomechanics of an implanted spinal motion segment. ⋯ Implantation of Cadisc™-L caused a reduction in axial stiffness, but maintained disc height and flexion stiffness. IAR loci remained mobile without large displacement of the centroid from the intact spine position.
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This study tested the hypotheses that (1) cervical total disc replacement with a compressible, six-degree-of-freedom prosthesis would allow restoration of physiologic range and quality of motion, and (2) the kinematic response would not be adversely affected by variability in prosthesis position in the sagittal plane. Twelve human cadaveric cervical spines were tested. Prostheses were implanted at C5-C6. ⋯ Implanting the prosthesis in the posterior position as compared to the middle position did not significantly affect the ROM, motion coupling, or stiffness of the reconstructed segment; however, the COR location better approximated intact controls with the prosthesis midline located within ± 1 mm of the disc-space midline. Overall, the kinematic response after reconstruction with the compressible, six-degree-of-freedom prosthesis within ± 1 mm of the disc-space midline approximated the intact response in flexion-extension. Clinical studies are needed to understand and interpret the effects of limited restoration of lateral bending and axial rotation motions and motion coupling on clinical outcome.