The spine journal : official journal of the North American Spine Society
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Brown-Séquard syndrome is characterized by a hemisection of the spinal cord most commonly after spinal trauma or neoplastic disease. The injury causes ipsilateral hemiplegia and proprioceptive sensory disturbances with contralateral loss of pain and temperature sensation. Patients with Brown-Séquard syndrome have the best prognosis of all spinal cord injury patterns. At this time, the ideal management for Brown-Séquard syndrome after penetrating trauma has yet to be defined. ⋯ Reinke et al. support surgical intervention for patients with incomplete paraplegia after the patient is medically stabilized, although their case report discussed lower thoracic injury, which carries a more favorable prognosis. All other prior case reports and prospective studies that reported favorable outcomes after Brown-Séquard syndrome involved the midthoracic, low thoracic, or lumbar spinal levels. This report is the first case of Brown-Séquard syndrome after a high cervical gun shot wound, which was managed with immediate decompression and fusion, where near complete recovery was obtained.
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Treatment of chronic and irreducible atlantoaxial dislocation (AAD) with ventral compression is challenging for surgeons. The main procedures are occipitocervical/C1-C2 fusion after transoral odontoidectomy or release of the periodontoid tissues. These surgical procedures, which are performed simultaneously or intermittently, have many disadvantages that may discount their effectiveness. Therefore, a more effective way to achieve surgical reduction and to keep solid stability with only a single procedure is needed. ⋯ This C1-C2 screw and rod system provides reliable stability and sufficient reduction of the anatomic malalignment at the craniovertebral junction and meanwhile retains the mobility of atlanto-occipital joints in the treatment of chronic and irreducible AAD. Sophisticated skills, thorough release of the facet joints, and intraoperative protection of the vertebral artery are key points to accomplish this technique.
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Previous studies have identified inconsistencies in physician conflict-of-interest disclosures at academic meetings. The Physician Payment Sunshine Act (PPSA) will require industry to disclose anything of value given to physicians by 2014. In preparation, some spine device companies have begun reporting payments online. ⋯ Discrepancy rates between what spine surgeons disclosed at NASS 2011 and what companies reported for their consultants were high. This is concerning given the passage of the PPSA as well as the increased public visibility of potential discrepancies. More uniform practices will certainly be necessary.
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Exercise has been shown to reduce pain and increase function in patients with chronic low back pain. However up to 70% of patients do not engage in prescribed home exercise. Physiotherapists need to understand more about the complex factors influencing patients' adherence to prescribed home exercise to tailor their exercise interventions more effectively and support patients to self-manage. ⋯ This is the first systematic review investigating adherence to prescribed home exercise in a chronic low back pain population. It is difficult to draw firm conclusions because the research lacks detailed descriptions of intervention content. The use of a taxonomy of behavior change techniques has been suggested to overcome this key problem. This review has highlighted the lack of standardized measures of adherence to prescribed home exercise. The development of a validated measure of adherence should be a priority because this will provide a better understanding of the multitude of factors that may influence adherence to home exercise.