The spine journal : official journal of the North American Spine Society
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Low back pain (LBP) is a common musculoskeletal disorder associated with a considerable social and economic burden within the working-age population. Despite an unclear etiology, numerous physical activities are suspected of leading to LBP. Declaring a causal relationship between occupational activities and LBP remains challenging and requires a methodologically rigorous approach. ⋯ The studies reviewed did not support a causal association between workplace manual handling or assisting patients and LBP in a Bradford-Hill framework. Conflicting evidence in specific subcategories of assisting patients was identified, suggesting that tasks such as assisting patients with ambulation may possibly contribute to LBP. It appears unlikely that workplace manual handling or assisting patients is independently causative of LBP in the populations of workers studied.
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Recurrent herniation of the nucleus pulposus (HNP) frequently causes poor outcomes after lumbar discectomy. The relationship between obesity and recurrent HNP has not previously been reported. ⋯ Obesity was a strong and independent predictor of recurrent HNP after lumbar microdiscectomy. Surgeons should incorporate weight loss counseling into their preoperative discussions with patients.
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Lumbar spinal stenosis (LSS) is a prevalent degenerative condition in the elderly that can be managed medically or with surgical treatments. Recent studies have shown an increase in the utilization of surgery in the United States and great regional variations. An understanding of treatment patterns and costs in a population-based setting will help identify subgroup differences to help inform strategies for optimal care in patients with LSS. ⋯ The surgical management of LSS varies with respect to timing and type of surgery provided. Such variation needs to be explained beyond demographic and comorbid factors.
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Anterior cervical discectomy and fusion (ACDF) is a common procedure used to treat radiculopathy and myelopathy from cervical degenerative disc disease. The complications for this procedure are well known. Dysphagia can occur in the postoperative setting. However, it is typically transient and does not last longer than 1 month after an operation. A de novo presentation of dysphagia occurring years after an operation is unique. Osteophyte formation can cause mass effect on the esophagus leading to obstruction of this conduit. However, there have been no reported cases of osteophyte growth fusing to surrounding structures leading to a functional dysphagia. ⋯ Functional dysphagia can occur in a delayed fashion after ACDF from osteophytes tethering the cervical plate to the surrounding contents of the neck used for swallowing. Freeing the contents of the neck from the tethering osteophytes can alleviate symptoms related to a dysfunctional swallowing mechanism.
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Traumatic spondyloptosis of the cervical spine is usually associated with a complete, or rarely a partial, neurological deficit. Traumatic spondyloptosis with bipedicular fracture of the C3 vertebra is uncommon. To the best of the authors' knowledge, there is no report in the literature of bipedicular fracture of C3 with spondyloptosis of C3 over C4 with no neurological deficit. Literature is not clear about the role of preoperative traction in neurologically intact patients, and most authors advise both anterior and posterior fixation for cervical spondyloptosis. ⋯ A case of C3-C4 spondyloptosis with associated C1-C2 posterior arch fracture is reported. The patient can present without neurological deficit if associated with a fracture of the posterior elements. Spondyloptosis without neurological deficit can be treated with gradual reduction under fluoroscopic guidance. A limited anterior-only fusion at the spondyloptosis level can provide good long-term results with preservation of other motion segments.