The spine journal : official journal of the North American Spine Society
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Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear. ⋯ This review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.
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The prevalence of scoliosis in Prader-Willi syndrome (PWS) is high; however, the prevalence of PWS is rare, with one person in 10,000 to 20,000 affected. The etiology and characteristics of scoliosis associated with PWS remain unidentified. In addition, it is believed that the speedup of growth associated with growth hormone (GH) supplement treatment may influence the deterioration of scoliosis in PWS. ⋯ Scoliosis in PWS can be classified into three types. A lumbar curve convex on the left side was found in most patients. In addition, severe deterioration of scoliosis was found in Type 2 patients. Therefore we recommend careful, ongoing observations for patients showing double curve tendencies.
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Biomechanical studies have demonstrated increased motion in motion segments adjacent to instrumentation or arthrodesis. The effects of different configurations of hook and pedicle screw instrumentation on the biomechanical behaviors of adjacent segments have not been well documented. ⋯ The use of sublaminar hooks to stabilize the motion segment above a circumferential lumbar fusion reduced motion at the next cephalad segment compared with a similar construct using pedicle screws. The semiconstrained hook enhancement may be considered if a patient is at a risk of adjacent segment disorders.
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Comparative Study
Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion.
Multilevel lumbar disc disease (MLDD) is a common finding in many patients. Surgical solutions for MLDD include fusion or disc replacement. The hybrid model, combining fusion and disc replacement, is a potential alternative for patients who require surgical intervention at both L5-S1 and L4-L5. The indications for this hybrid model could be posterior element insufficiency, severe facet pathology, calcified ligamentum flavum, and subarticular disease confirming spinal stenosis at L5-S1 level, or previous fusion surgery at L5-S1 and new symptomatic pathology at L4-L5. Biomechanical data of the hybrid model with the Maverick disc and anterior fusion are not available in the literature. ⋯ The Maverick disc preserved total motion but altered the motion pattern of the intact condition. This result is similar to unconstrained devices such as Charité. The motion at L4-L5 of the hybrid model is similar to that of two-level Maverick disc replacement. The fusion procedure using an anterior plate significantly reduced intact motion. Clinical studies are recommended to validate the efficacy of the hybrid model.
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Pedicle screw malposition rates using conventional techniques have been reported to occur with a frequency of 6% to 41%. The upper thoracic spine (T1-T3) is a challenging area for pedicle screw placement secondary to the small size of the pedicles, the inability to visualize this area with lateral fluoroscopy, and significant consequences for malpositioned screws. We describe our experience placing 150 pedicle screws in the T1-T3 levels using three-dimensional (3D) image guidance. ⋯ Upper thoracic pedicle screw placement is technically demanding as a result of variable pedicle anatomy and difficulty with two-dimensional visualization. This study demonstrates the accuracy and reliability of 3D image guidance when placing pedicle screws in this region. Advantages of this technology in our practice include safe and accurate placement of spinal instrumentation with little to no radiation exposure to the surgeon and operating room staff.