Spine
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Randomized Controlled Trial Clinical Trial
The functional restoration approach to the treatment of chronic pain in patients with soft tissue and back injuries.
A prospective randomized study of 542 injured workers with continuing pain compared 271 workers who were treated at either one of two clinics that provided functional restoration with a control group of 271 subjects. Chronic pain was caused by low back injury in 78% of patients; 79% of those treated were at work 12 months after completion of treatment compared with 78% of the control subjects. When the patients were divided into subsets, based on the accident date and followed monthly, the duration of absence from work, the compensation costs, the disability award costs, and the total costs were less for those treated than the control subjects, but these were not statistically significant. Using the difference in total costs as a measure of relative success, back injuries had better results than other injuries in this study.
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Anatomical study of L4 nerve branch, L5 nerve root, and bony stock in the sacroiliac region was performed in cadaveric specimens to provide anatomical references for anterior fixation of the sacroiliac joint. At 1 cm intervals along the sacro-iliac joint, the distance to the lateral border of the L4 nerve branch (to the lumbosacral trunk) and the L5 nerve root was measured. Computed tomography scans and cadaveric sectioning of the sacro-iliac region were performed to evaluate the bony stock available for fixation and the optimal screw direction to prevent neurologic damage. ⋯ Four centimeters cephalad to the pelvic brim, the AP dimension of Sl complex was decreased. Screws that were 1 cm medial to the Sl joint and directed posteriorly and parallel to the joint did not endanger neurologic structures. At four centimeters above the pelvic brim, there is less danger of neurologic injury; however, a decrease in sacral bony stock may affect fixation.
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Case Reports
Reversible urinary retention secondary to excessive morphine delivered by an intrathecal morphine pump.
Reversible complication of intrathecal morphine delivered by an implanted pump is described in one patient. The patient was evaluated initially using a contrast CT of the thoracic spine as well as urodynamics studies. ⋯ Implanted pumps to deliver intrathecal narcotic medications are being used currently to treat intractable pain. This is a case report of reversible urinary retention secondary to the intrathecal narcotic.
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This article describes a patient with transdural lumbar disc herniation. The patient fits the average criteria for intradural lumbar disc herniations. ⋯ The volume of extruded matter was greater and caused greater neurologic damage than that observed in intradural disc herniations. The authors know no previous cases of transdural disc herniations.