Journal of neurosurgery. Spine
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Meta Analysis Comparative Study
Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review.
Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit. ⋯ There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.
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Review Case Reports
Nonmissile penetrating spinal injury. Case report and review of the literature.
Nonmissile penetrating spinal injuries (NMPSIs) are rare, even among the population of patients treated in large trauma centers. Patients who present with retained foreign body fragments due to stabbings represent an even smaller subset of NMPSI, and their optimal management is unclear. The authors report the case of a 42-year-old man who presented to the University of California at Davis Medical Center with a retained knife blade after suffering a stab wound to the lower thoracic spine. ⋯ Surgical removal of a retained foreign body is generally recommended in these patients because the fragments may lead to a worse neurological outcome. Perioperative antibiotic therapy may be beneficial, but the result depends on the nature of the penetrating agent. There is no documentation in the literature to support the use of steroid agents in patients with NMPSIs.
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Comparative Study
Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures.
Cervical radiofrequency neurotomy (CRFN) is used in the treatment of patients with chronic pain and disability due to whiplash injury. Confirmation of its efficiency has, however, been based solely on pain and psychological distress factors. The aim of the present study was to extend the assessment of CRFN efficacy by adding other outcome measures to shed light on neuromotor-functional-psychological interactions by undertaking comparison of pre- and 1-year postintervention data. ⋯ Approximately 1 year after intervention, CRFN was associated with an acceptable rate of success, as reflected by objective and subjective outcome measures.
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The authors evaluated the efficacy and safety of so-called chimney sublaminar decompression, a new technique to decompress the degenerative stenotic lumbar spinal canal without stripping of the paravertebral muscles. ⋯ Compared with laminectomy or endoscopic surgery, the aforementioned chimney sublaminar decompression technique was an equally effective and less invasive technique in the treatment of degenerative lumbar canal stenosis.
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The thoracic spine is stabilized in the anteroposterior direction by the rib cage and the facet joints. Spondylolisthesis of the thoracic spine is less common than that of the lumbar spine. The authors describe a rare case of thoracic spondylolisthesis in which the patient suffered back pain and myelopathy. ⋯ To achieve posterior T10-12 decompression, the surgeons performed a laminectomy and posterolateral fusion in which a pedicle screw fixation system was placed. The patient's back pain disappeared immediately after the operation. The authors conclude that the enlargement of the pedicle-facet joint angle and the degenerative changes of the facet joint caused the thoracolumbar spondylolisthesis.