Spine
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Comparative Study
Ethnic and sex differences in response to clinical and induced pain in chronic spinal pain patients.
There is widely held clinical opinion and some tentative research justification for stereotypic or ethnic and sex differences in response to pain. To more adequately test this notion, 60 chronic spinal pain patients (black, Mexican American, and Caucasian, with ten men and ten women per group), all having persistent spinal pain for over 1 year, were studied. They were administered the ischemic pain test, a numerical estimate of spinal pain, and two independent raters scaled the amount of pain emphasis, based upon the patient's physical condition and pain behaviors. ⋯ They also indicated that they more nearly approached their pain tolerance. It was concluded that while ethnic and sex differences were found, stereotypic responses were not uniform, and tended to be related to the manner in which that pain was assessed. These results are discussed in light of cultural differences.
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The relationship between herniated lumbar disc and abnormalities of the transverse process of the lumbosacral junction was investigated. Two hundred consecutive patients with positive myelographic findings of herniated lumbar disc were reviewed. Sixty patients presented abnormalities of the transverse process to satisfy the criteria for lumbosacral transitional vertebra. ⋯ In types III and IV, there are no herniations at the level of the lumbosacral transitional vertebra and no increase in the incidence of herniations just proximal to the lumbosacral transitional vertebra. The Type II lumbosacral transitional vertebra presents herniated lumbar disc at the level of transition. It also presents a greater than normal incidence of herniations at the level just above the lumbosacral transitional vertebra.
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From this literature, we have made the following conclusions: (1) Complete cord lesions do not recover cord functional motor control. (2) Complete lesions recover one nerve root level of function at the fracture site. (3) Partial lesions recover partially. (4) The less the injury, the greater the recovery. (5) Brown-Sequard lesions recover more than central cord syndromes, which recover more than anterior cord syndromes. (6) Reduction of dislocated facets facilitates nerve root recovery. (7) Better documentation of specific pathology and recovery rates are necessary to determine the surgical benefits in complete lesions, incomplete lesions, and nerve root recovery.
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From April 1978 to October 1982, the authors performed 44 pelvic fixations as part of L-rod instrumentation of a spinal deformity. Thirty scoliosis and revision scoliosis cases with a minimum of 1 year follow-up were analyzed for changes of the instrumentation with respect to the pelvis, angular changes at the lumbosacral junction, radiolucency about the portions of the rods providing pelvic fixation, and success of lumbosacral fusion. The technique for fixation was different among three groups of patients. A pelvic fixation technique in which the pelvic segments of the rods were longer than 6 cm, completely intraosseous through their iliac course, and within 1.5 cm of the sciatic notch, yielded the best results.
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Twenty patients with atlanto-axial instability treated by posterior spinal fusion were reviewed. Patients with atlanto-axial instability due to congenital causes usually presented late with chronic myelopathy and treatment in these patients was associated with poor surgical results. Atlanto-axial fusion for fracture non-unions offers immediate stability, reliability, few complications, and good range of neck movement after surgery. Occipito-cervical fusion is indicated whenever atlanto-axial fusion is surgically not feasible.