Spine
-
A retrospective study of patients with rigid coronal decompensation. ⋯ Patients with fixed, decompensated spinal deformity may be safely corrected by vertebrectomy, decancellation, spinal shortening, instrumentation, and fusion. Complications are transient, and the benefits in this select group of patients outweigh the risks.
-
A two-part observational study. In Part 1, consecutive lumbar magnetic resonance imaging scans in patients with sciatica meeting enrollment criteria were prospectively and blindly analyzed by a set protocol. In Part 2, further clinical findings at the time of the magnetic resonance imaging were obtained by retrospective chart review and outcome assessment done at follow-up of more than 2 years. ⋯ Quantitative measurements by magnetic resonance imaging of disc and canal morphology of 188 patients with sciatica indicate a wide range of herniation and canal sizes, with significant differences between men and women. In a cohort of 135 patients followed for more than 2 years, demographic and clinical features appeared to predict outcomes of nonoperative treatment, whereas morphometric features of disc herniation and the spinal canal seen on magnetic resonance imaging were much more powerful predictors of surgical outcomes.
-
A 25-year follow-up study of 606 members of the population-based Framingham cohort, who had received lateral lumbar radiographs in 1967-1968 and 1992-1993, and completed an interview on back symptoms at the second examination. ⋯ Advanced aortic atherosclerosis, presenting as calcific deposits in the posterior wall of the aorta, increases a person's risk for development of disc degeneration and is associated with the occurrence of back pain.
-
Analysis of the treatment-outcome predictive power of Waddell signs by evaluating them before and after functional restoration, with assessment of 1-year socioeconomic outcomes. ⋯ Although positive Waddell signs have been found to be predictive in patients with short-term chronic low back pain, the current results suggest that, in patients who have longer duration of pain and who undergo a comprehensive functional restoration program, these signs are not significantly prognostic. Because functional restoration is an interdiscipilinary approach that effectively manages somatization complaints in a consistent manner by all treatment personnel, such complaints do not create any major barriers to recovery. Therefore, although Waddell signs may be predictive of treatment outcome in less intensive rehabilitation programs, they do not provide any predictive power in a comprehensive functional restoration program, which has a basic goal of managing barriers to recovery in a clinically efficacious manner.
-
A case report is presented of an unusual complication of scoliosis surgery that, to the authors' knowledge, has never been reported in the literature. ⋯ Although clinical examination may be difficult to perform in patients who are unconscious, on large doses of narcotic drugs, or mentally retarded, careful observation during the postoperative period and awareness of this complication can allow early detection of impending reversible neurologic deficit and provision of appropriate treatment.