Spine
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A cohort study was undertaken using medical claims of Medicare beneficiaries. ⋯ Reoperation rates are affected not only by technical factors, but also by demographic and clinical characteristics that are often omitted from reports of surgical case series.
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Case Reports
Neurologic injury after insertion of laminar hooks during Cotrel-Dubousset instrumentation.
Although the use of Cotrel-Dubousset (CD) instrumentation has improved results of operative treatment of scoliotic deformities, this technique may be associated with increased risk of neurologic injury. ⋯ These cases demonstrate that caution should be exercised during introduction of laminar hooks on the concave side during CD instrumentation for scoliotic deformities. Continuous neurophysiologic monitoring of spinal cord conduction may aid in early detection of local compression at the spinal cord or cauda equina level.
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The shape and size of the pedicles of the human spine differs within different races. The authors studied the diameters and angles of the spine pedicle from the T1 to L5 levels in Koreans. The following measurements were made 1) transverse diameter, 2) superoinferior diameter, 3) anteroposterior pedicle angle, 4) horizontal pedicle angle, and 5) pedicle axis angle. ⋯ The results suggest that using 6-mm screws can violate the cortex of the pedicles in a significant number of levels of the upper lumbar spine. Using a screw longer than 40 mm is dangerous in the lower thoracic spine of a Korean. A statistical difference exists between the transverse diameter of the pedicles of Westerners and Koreans.
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The structure-function relationship of anulus fibrosus of nondegenerate lumbar intervertebral discs was investigated. ⋯ The regional differences in tensile properties may result predominantly from structural rather than compositional variations and may contribute to the clinical frequency of anulus failure in the posterolateral region.
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Randomized Controlled Trial Clinical Trial
Intensive physical and psychosocial training program for patients with chronic low back pain. A controlled clinical trial.
The authors conducted a controlled clinical trial with 1-year follow-up to define the effectiveness of an intensive physical and psychosocial training program on patients with low back pain. ⋯ The intervention program could improve physical disability, but to improve occupational handicap, activities of the whole society (social legislation, labor market policy) are needed.