The spine journal : official journal of the North American Spine Society
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Diastematomyelia is uncommon and rarely presents in adulthood. This report draws attention to the fact that patients who underwent spinal fusion for deformity before the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) may have unrecognized spinal cord abnormalities. This should be considered if revision surgery is contemplated. ⋯ Progressive weakness without any previous neurologic deficit or neurocutaneous stigmas of an underlying spinal cord abnormality may develop in the adult with unrecognized diastemotomyelia. This case demonstrates that a thorough preoperative workup of patients with complex spinal deformities is imperative.
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Few empirical data are available that document changes in population-based rates for the evaluation and treatment of nonspecific back pain. ⋯ The national pattern of health care for nonspecific low back pain observed in the present study serves as a basis for future investigations into the management of this major public health problem. Findings suggest that perhaps a duplication of care is partly responsible for the high degree of health care utilization in this population.
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In preclinical and clinical joint replacement applications, porous tantalum has been shown to be osteoconductive and effective for biological fixation. Relatively little research has been undertaken to investigate the porous tantalum implants for potential application in intervertebral spinal fusion. ⋯ In this porcine ALIF model, the radiographic and histological appearances of the porous tantalum ring were equivalent to those of the carbon fiber cage. The high presence of radiolucencies and fibrous tissue layer at the vertebrae-implant interface suggests that an initial stabilizing biomechanical environment is important in order to achieve bone ingrowth in the interbody fusion devices in this ALIF model.
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Comparative Study
Spinal canal enlargement procedure by restorative laminoplasty for the treatment of lumbar canal stenosis.
Multilevel fenestration or laminectomy is generally performed to treat the patient with lumbar canal stenosis (LCS). However, in patients requiring laminectomy, little attention has been paid to the later development of lumbar pain possibly caused by a removal of the posterior elements of the spine. In general, spinal instrumentation and fusion has been generally performed when laminectomy might cause severe postoperative spinal instability. Surgical methods where osteotomized vertebral arches are repositioned rather than removed have long been performed. However, they have never become widespread, possibly because of the complicated surgical procedures and poor postoperative arch stability, which leads to a long period of postoperative immobilization. ⋯ Our surgical procedures of spinal canal enlargement using restorative laminoplasty produce complete decompression and anatomical reconstruction of the posterior elements, ligaments and muscles. Improvement in complaints of lumbago may be a consequence of the anatomical reconstruction of the posterior spinal elements. Overall, favorable results were obtained. The best results were obtained if surgery is performed within 2 years of the onset of LCS.
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Comparative Study
Intradiscal electrothermal therapy (IDET) for chronic low back pain in active-duty soldiers: 2-year follow-up.
Intradiscal electrothermal therapy (IDET) is a new treatment option for chronic discogenic low back pain that is minimally invasive and has demonstrated success rates equal to or better than those for spinal fusion at short-term follow-up. ⋯ IDET is not a substitute for spinal fusion in the treatment of chronic discogenic low back pain in active-duty soldiers. Our reasonable early results diminished with time and up to 20% of patients report worsening of baseline symptoms at final follow-up. IDET will prove its role in the treatment of chronic discogenic low back pain as more outcome data are obtained, but for now we consider it, at best, an antecedent rather than alternative to spinal fusion.