Spine
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Comparative Study
Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.
A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. ⋯ The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.
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Comparative Study
Lumbar lordosis in spinal fusion. A comparison of intraoperative results of patient positioning on two different operative table frame types.
One hundred one patients undergoing spine surgery for degenerative conditions were entered into a prospective radiographic evaluation of changes in lumbar lordosis as affected by positioning on two different operative tables. ⋯ Results from the present study display a statistically significant difference between multisegmental and total lumbar lordosis, depending on the type of operative table used in patient positioning. Segmental lordosis at L5-S1 depended less on frame type. This table-dependent positional change in lumbar lordosis could be incorporated easily into a lumbar fusion procedure, especially when supplemented with instrumentation, affecting the permanent overall degree of lordosis. These results suggest that a more physiologic degree of lumbar lordosis is obtained accurately with use of an operative table similar to the four-poster frame.
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The authors studied the origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats by resection of the sympathetic trunks. ⋯ The results showed that the posterior portion of lumbar intervertebral discs was innervated by the sympathetic nerves multisegmentally and bilaterally.
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An inception cohort design was used to study a consecutive sample of back-injured workers. ⋯ The Vermont Disability Prediction Questionnaire is a brief, easily administered and scored tool for identifying back-injured workers at relative risk for chronic disability. Such early identification should increase the efficiency of disability prevention strategies by directing them toward people who need them most. The accuracy of the questionnaire needs to be tested in a variety of different clinical and socioeconomic settings.