Spine
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Multicenter Study Comparative Study
Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes.
A prospective, multicenter observational study. ⋯ Findings were limited by the small number of participating surgeons, modest sample size that produced P values of borderline significance, and nonrandomized design. With these caveats in mind, the authors conclude: (1) The individual surgeon was a more important correlate of the decision to perform arthrodesis than clinical variables such as spondylolisthesis. (2) Noninstrumented arthrodesis resulted in superior relief of back pain after 6 and 24 months. (3) Instrumented arthrodesis was the most costly option. These results highlight the need for randomized controlled trials and cost effectiveness analyses of lumbar arthrodesis and instrumentation in patients with degenerative lumbar spinal stenosis.
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A nationwide, cohort-based cross-sectional questionnaire survey as a part of a population study. ⋯ Low back pain is a relatively common complaint at adolescence. In addition, a significant part of the pains are recurrent or chronic already with 14-year-old adolescents.
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In this study, the authors analyzed the results of the release of the medial superior cluneal nerve in a prospective series of 19 patients with suspected entrapment. ⋯ Entrapment neuropathy of the medial superior cluneal nerve is a rare and easily treatable cause of unilateral low back pain.
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Rabbits were used as an experimental model in the study of motor-evoked potentials. ⋯ Intraoperative monitoring of descending pathways by means of motor-evoked potentials during anesthesia of the rabbits based on nitrous oxide is feasible when neural activity is evaluated. Higher doses of nitrous oxide, however, are not compatible with recording of muscular activity.
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This study was designed to examine the possibility of a new spinal cord monitoring method using measurement of the refractory period to monitor spinal cord function. ⋯ The change of the responses elicited by the paired stimuli is more sensitive than those elicited by the single stimulus in the spinal cord evoked potentials. The absolute refractory periods and the recovery rate during 50% attenuation of the precompression amplitude is the critical alarm level in spinal cord monitoring.