Spine
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The authors reviewed 246 idiopathic scoliosis patients with the upper thoracic curve of more than 20 degrees. Group I (138 patients) had positive T1 tilt and a spinal fusion which was extended over both the upper and lower thoracic curve with the diagnosis of double thoracic curve. Group II (43 patients) had positive T1 tilt, but the fusion was limited to the lower thoracic curve. ⋯ Correction and fusion on the lower curve (groups II and III) aggravated shoulder imbalance of all patients with left shoulder elevation. Based on the findings of this study, the authors proposed that the diagnosis of idiopathic double thoracic patterns should be limited to those patterns which require fusion of both the upper and lower curves. This pattern of idiopathic scoliosis includes double thoracic curves with left shoulder elevation and/or a rigid upper thoracic curve.
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Randomized Controlled Trial Comparative Study Clinical Trial
The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam.
To study the natural history of acute sciatica, 208 patients with obvious symptoms and signs of a lumbar radiculopathy (L5 and S1) were examined within 14 days of onset. A concomitant double-blind investigation of the effect of the nonsteroidal anti-inflammatory drug piroxicam was performed. ⋯ Based on questionnaires at months 3 and 12 approximately 30% of the patients still complained about back trouble and 19.5% were out of work after 1 year. Four patients underwent surgery during this period.
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Comparative Study
Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population.
Regional variations in lumbar spinal fusion rates suggest a poor consensus on surgical indications. Therefore, complications, costs, and reoperation rates were compared for elderly patients undergoing surgery with or without spinal fusion. Subjects were Medicare recipients who underwent surgery in 1985, with 4 years of subsequent follow-up. ⋯ Six-week mortality was 2.0 times greater for patients undergoing fusions (P = 0.025). Reoperation rates at 4 years were no lower for patients who had fusion surgery and results were similar in most diagnostic subgroups. Indications for fusion among older patients require better definition, preferably based on outcomes from prospective controlled studies.