The spine journal : official journal of the North American Spine Society
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Comparative Study Observational Study
Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis.
Currently, treatment for patients diagnosed with noncomplicated (ie, known infectious agent, no neurologic compromise, and preserved spinal stability) pyogenic spondylodiscitis (PS) is based on intravenous antibiotics and rigid brace immobilization. Since January 2010, we started offering our patients percutaneous posterior screw-rod instrumentation as an alternative approach to rigid bracing. Supposed benefits of posterior percutaneous instrumentation over rigid bracing are earlier free mobilization, increased comfort, and faster recovery. ⋯ Posterior percutaneous spinal instrumentation is a safe, feasible, and effective procedure in relieving pain, preventing deformity, and neurologic compromise in patients affected by noncomplicated lower thoracic (T9-T12) or lumbar PS. Posterior instrumentation did not offer any advantage in healing time over TLSO rigid bracing because infection clearance is strongly dependent on proper antibiotic therapy. Nevertheless, surgical stabilization was associated with faster recovery, lower pain scores, and improved quality of life compared with TLSO conservative treatment at 1, 3, and 6 months after treatment.
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Randomized Controlled Trial
Allograft alone versus allograft with bone marrow concentrate for the healing of the instrumented posterolateral lumbar fusion.
Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure. ⋯ We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.
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Observational Study
Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study.
The natural history of cervical degenerative disease with operative management has not been well described. Even with symptomatic and radiographic evidence of multilevel cervical disease, it is unclear whether single- or multilevel anterior cervical discectomy and fusion (ACDF) procedures produce superior long-term outcomes. ⋯ In this study, we report rates of adverse events and the need for revision surgery in patients undergoing single versus multilevel ACDFs. Increasing number of levels fused at the time of index surgery correlated with increased rate of reoperations. Multilevel ACDF patients requiring additional surgery more often underwent more extensive revision surgeries.
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Nonorganic low back pain (NOLBP) is common in the worker's compensation (WC) population. Consults with specialists constitute an unnecessary cost to the system, and a means of screening for these patients is necessary. ⋯ We found a significant association between certain easily identifiable criteria and NOLBP in a cohort of WC patients. These criteria included mechanism of injury including slip and fall or lifting of a patient, alleged injury in greater than two bodily areas, presence of concomitant cervical and/or thoracic complaints, initial presentation to chiropractor, and areas of pain different from first report of injury. More than 95% of patients with three or more of the aforementioned criteria were found to have nonorganic pain. This information may help the specialist and the WC provider identify patients at a high risk for nonorganic pain, thereby reducing unnecessary costs.
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Randomized Controlled Trial
Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial.
There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. ⋯ The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.