Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia.
A prospective, randomized, double-blind clinical trial. ⋯ These data suggest that there is no clinical advantage of epidural opiate/local anesthetic analgesia over systemic opiate by patient-controlled analgesia for spinal fusion patients. However, possible technical limitations (namely, the low dosage of bupivacaine and placement of the catheter tip) may have prevented adequate delivery of anesthetic to the involved segments. Although the incidence of side effects is similar, cost factors and a high incidence of epidural catheter dislodgment favor use of patient-controlled analgesia.
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Case Reports
Fracture-dislocation at the thoracolumbar junction in an infant with locked vertebrae. A case report.
A retrospective, single-patient case report. ⋯ Fracture-dislocation at the thoracolumbar junction is rare in infancy. This is probably due to unique anatomic and biomechanical features of the spine in infancy.
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Retrospective review of acute axis fractures treated at a tertiary referral center. ⋯ Type II odontoid fractures have the highest nonunion rate and were associated with dens displacement of 6 mm or greater. Early surgical fusion is recommended for acute fracture instability despite external immobilization, transverse ligament disruption, Type II odontoid fractures with dens displacement of at least 6 mm on admission, or severe Francis grade or Effendi-type hangman's fractures. Otherwise, nonoperative management is sufficient.
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Clinical Trial
Clinical analysis of two-level compression of the cauda equina and the nerve roots in lumbar spinal canal stenosis.
This study is a prospective, clinical study assessing the efficacy of selective decompression of the responsible level in two-level stenosis in accordance with neurologic findings defined by the gait load test, and functional diagnosis based on selective nerve root block. ⋯ Two-level stenosis in patients with lumbar spondylosis is associated with production of cauda equina lesions. The gait load test provides information regarding changes in symptoms and neurologic condition during exercise. The responsible levels should be determined based on neurologic findings after the gait load test and a selective nerve root block. It is uncommon for both stenotic levels to be symptomatic in patients with two-level stenosis. Less invasive surgery such as selective decompression for the responsible level in patients with two-level stenosis is a useful technique with a good potential for long-term success.
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This retrospective study was conducted to analyze the clinical results in 45 patients with nontraumatic lesions of the cervical spine treated by pedicle screw fixation. ⋯ Pedicle screw fixation is a useful procedure for posterior reconstruction of the cervical spine. This procedure does not require the lamina for stabilization, and should be especially valuable for simultaneous posterior decompression and fusion. The risk to neurovascular structures, however, cannot be completely eliminated.