Spine
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Clinical Trial
Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis.
The effectiveness of duration of antituberculous chemotherapy in conjunction with radical surgery for tuberculosis of the spine is reported. One hundred fourteen patients were followed prospectively for a mean period of 14.6 years after radical resection of the tuberculous lesion and reconstruction of the resultant gap with bone graft. ⋯ The authors' findings show that a 6-month chemotherapeutic regimen combined with surgical excision and bone grafting is adequate for management of tuberculosis of the spine, as it produced clinical and radiologic results comparable with the 18-month chemotherapeutic regimen.
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Randomized Controlled Trial Clinical Trial
Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study.
The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks. ⋯ Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.
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Comparative Study
The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica.
The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. ⋯ Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.
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Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present. ⋯ Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.
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Review Case Reports
Traumatic spondylopelvic dissociation. A case report and literature review.
A case of traumatic spondylopelvic dissociation and a method of fixation are described. ⋯ The unique fracture pattern described in this patient is presented to offer better insight into management of this complex injury and to delineate it from simpler patterns of injury to the lumbosacral junction.