Spine
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Comparative Study Clinical Trial Controlled Clinical Trial
One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up.
A study of postural control during one-footed and externally disturbed two-footed stance among healthy control subjects and patients with chronic low back pain at the beginning of a functional back restoration program and 6 months later at follow-up examination. ⋯ Impaired postural stability seems to be one factor in multidimensional symptomatology of patients with chronic low back trouble. Postural stability is easily disturbed in case of impairment in strength, coordination, or effective coupling of muscles in the lumbar and pelvic area. Patients with chronic low back pain seem to experience impairment in these functions, which should be taken into consideration when back rehabilitation programs are planned.
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Case Reports
Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports.
Intrinsic cervical spinal cord damage represents the serious and permanent complications that can occur if cervical epidural steroid injections are administered while the patient is sedated. Two case reports are presented. ⋯ These case reports indicate fluoroscopic guidance will not insure or prevent intrathecal perforation or spinal cord penetration during the administration of cervical epidural steroid injections. In addition, although intravenous sedations during cervical epidural steroid injections have been used numerous times without reported complications, it appears intravenous sedation in these two cases resulted in the inability of the patient to experience the expected pain and paresthesias at the time of spinal cord irritation. Therefore, the authors conclude that the patient should be fully awake during the administration of cervical epidural steroid injections, with only local anesthetic in the skin used for analgesia.
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This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. ⋯ The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Components of initial and residual disability after back injury in nurses.
A pre- versus postintervention with concurrent control group design was used to investigate the effect of a workplace-based early intervention program on perception of disability in nurses with low back injury. ⋯ Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job-related activities persisted. Residual disability after back injury should be addressed in workplace-based prevention programs.
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A retrospective study by an independent observer of a consecutive series of 67 cases of adolescent idiopathic scoliosis presenting with a King II curve pattern. ⋯ The concept of selective thoracic fusion in the King II curve pattern appears to be valid. These findings suggest that arthrodesis of the lumbar spine can be avoided when this pattern is properly diagnosed and appropriately treated. Proper identification of the stable and neutral vertebra and of the appropriate level of fusion are important to achieve good postoperative balance. Successful preservation of lumbar motion segments is important to long-term satisfactory outcome in adolescent idiopathic scoliosis.