The spine journal : official journal of the North American Spine Society
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Review Comparative Study
Pain, malingering and the WAIS-III Working Memory Index.
Pain patients often report cognitive symptoms, and many will include them in their claims of disability. There is empirical evidence that patients with pain do experience problems on attention-demanding cognitive tasks, but the results are mixed and the potential impact of exaggeration in the context of pain-related litigation has not been addressed. ⋯ This study demonstrated that even when controlling for exaggeration some pain patients do exhibit problems with attentional function. However, significant impairment in WMI performance (eg, index score
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Randomized Controlled Trial
A prospective study of Autologous Growth Factors (AGF) in lumbar interbody fusion.
Numerous preclinical and clinical studies have reported on the use of platelet concentrates to promote tissue healing. The results in spinal fusion applications are limited and controversial. ⋯ AGF combined with an allograft carrier is equivalent in radiographic and clinical outcomes to autograft in one- or two-level lumbar interbody fusion with supplemental posterior fixation and, thus, eliminates any morbidity from iliac crest bone graft harvesting. AGF combined with an appropriate carrier is a reasonable alternative to autograft and expensive bone induction technologies. Further research is still required to examine the optimum carriers, preparation and formulation, and platelet concentrations for this technology.
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Comparative Study
Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis.
Current surgical trends increasingly emphasize the minimization of surgical exposure and tissue morbidity. Previous research questioned the ability of unilateral pedicle screw instrumentation to adequately stabilize posterior fusion constructs. No study to date has addressed the effects of reduced posterior instrumentation mass on interbody construct techniques. Unilateral surgical exposure for transforaminal lumbar interbody fusion (TLIF) allows ipsilateral pedicle screw placement. Theoretically, percutanous contralateral facet screw placement could provide supplemental construct support without additional surgical exposure. ⋯ All tested TLIF constructs with posterior instrumentation decreased segmental range of motion and increased segmental stiffness. While placing unilateral posterior instrumentation decreases overall implant bulk and dissection, it allows for significantly increased segmental range of motion, less stiffness, and produces off-axis movement. The technique of contralateral facet screw placement provides the surgical advantages of unilateral pedicle screw placement with stability comparable to TLIF with bilateral pedicle screws.
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Comparative Study
Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment.
Many studies have documented the efficacy of lateral mass screws, but there are no studies examining the alignment maintenance capability and few large studies examining the complications associated with the use of these devices in cervical spine trauma. ⋯ The use of lateral mass screws for traumatic injuries of the cervical spine is associated with excellent maintenance of alignment and minimal complications.
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Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. ⋯ Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.