The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Jan 2012
Review Comparative StudyAnterior approach for complex cervical spondylotic myelopathy.
Cervical spondylotic myelopathy (CSM) is a slowly progressive disease resulting from age-related degenerative changes in the spine that can lead to spinal cord dysfunction and significant functional disability. The degenerative changes and abnormal motion lead to vertebral body subluxation, osteophyte formation, ligamentum flavum hypertrophy, and spinal canal narrowing. ⋯ Disease extent and location dictate the choice of surgical approach. Anterior spinal decompression and instrumented fusion is successful in preventing CSM progression and has been shown to result in functional improvement in most patients.
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Orthop. Clin. North Am. · Oct 2011
ReviewManagement of degenerative disk disease and chronic low back pain.
Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. ⋯ Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans.
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Orthop. Clin. North Am. · Oct 2011
Review Comparative StudyProsthetic total disk replacement--can we learn from total hip replacement?
Total lumbar disk replacement has become a routine procedure in many countries. However, discussions regarding its use are ongoing. ⋯ A review of the development of this technology, since the development of the first successful implantation of a total lumbar disk prosthesis in 1984, shows an amazing analogy to the history of total hip replacement. This article is a one-to-one comparison of the evolution of total hip and total lumbar disk replacement from "skunk works" to scientific evidence.
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Degenerative changes in the material properties of nucleus pulposus and anulus fibrosus promote changes in viscoelastic properties of the whole disc. Volume, pressure and hydration loss in the nucleus pulposus, disk height decreases and fissures in the anulus fibrosus, are some of the signs of the degenerative cascade that advances with age and affect, among others, spinal function and its stability. Much remains to be learned about how these changes affect the function of the motion segment and relate to symptoms such as low back pain and altered spinal biomechanics.
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Orthop. Clin. North Am. · Apr 2011
Review Comparative StudyComparison of functional results of hip resurfacing and total hip replacement: a review of the literature.
Total hip arthroplasty (THA) results in good outcomes in function and risk for revision in older patients. However, in young, active patients, it results in an increased rate of revision and poorer outcomes. ⋯ The selection of an appropriate prosthesis is critical for this patient demographic. This review compares the functional results of THA and HRA and focuses on range of motion, activity level, groin pain, patient satisfaction, restoration of normal hip anatomy, and gait.