The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial Multicenter Study
Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial.
Spinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other. ⋯ Upper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
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Understanding patient expectations is a critical component of patient-centered care; however, little is known about which expectation(s) are most important to patients as they relate to their sense of postoperative success. ⋯ Our findings highlight the need to identify and address specific individual expectations as part of the shared decision-making and presurgery education process.
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Comparative Study
Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty.
Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. ⋯ Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.
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Multicenter Study
How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients?
The lowest instrumented vertebra (LIV) determination in Lenke type 5 Adolescent Idiopathic Scoliosis (AIS) requires a thorough understanding and prediction of the correction force on the LIV from coronal, sagittal, and axial plane. Although many LIV selection criteria have been reported, none of them comprehensively evaluated the multidimensional characteristics of the LIV till now. ⋯ The present study indicates using our LIV criteria, our study achieved the correction rate of thoracolumbar/lumbar curve as 88.9%, with the rate of adding on or coronal imbalance as 8.7% (12/138). The criteria may provide important guidance for preoperative decision-making in Lenke 5 AIS patients, and more multicenter prospective studies with larger samples are needed to further validate the findings of this study.
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Narcotic use amongst patients suffering from lumbar radiculopathy is common, but the clinical benefit of narcotics for lumbar radiculopathy is likely minimal. It is unknown what the impact of preoperative use of narcotics has on outcomes related to lumbar microdiscectomy. ⋯ Our results demonstrate that patients that use opioids prior to lumbar microdiscectomy have equivalent postoperative outcomes as those that do not use opioids. Use of higher doses of opioids is associated with worse short-term outcomes.