Spine
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Dissection and observation of the dorsal root ganglion of the second cervical spinal nerve bilaterally. ⋯ The C2 dorsal dorsal root ganglia are all proximally placed and occupy most of the foramen height, which may render the C2 ganglion vulnerable to entrapment.
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A longitudinal cohort study (n = 448) comparing functionally restored discectomy (n = 123) and fusion (n = 101) workers' compensation patients to matched, unoperated control patients (n = 123 and n = 101, respectively). ⋯ Discectomy patients had work, health care utilization, and recurrent injury outcomes comparable with those for unoperated control patients. Fusion patients had better outcomes of work retention, reoperation, and health care use compared with the unoperated control patients and even with discectomy patients, in spite of more cases of previous surgery and greater duration of disability. The discectomy and fusion cohorts of operated chronic spinal disorder compensation patients with subsequent functional restoration had the best documented outcomes found in the literature for this population. In spite of the common presumption that spine surgery patients fare poorly in a workers' compensation environment, these results demonstrate that such patients can show remarkably successful objective outcomes if accompanied by effective rehabilitation, documenting efficacy and clinical utility. A new clinical approach is required to evaluate prospectively the combination of surgery and rehabilitation in chronic pain/disability workers' compensation patients, in which the surgical role is to correct an anatomic lesion, but the socioeconomic outcomes either occur spontaneously or are effected through some form of rehabilitation.
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A longitudinal observational study of primary care patients with low back pain. ⋯ Nonsteroidal anti-inflammatory drugs, often augmented by muscle relaxants, are a standard medical treatment for back pain in primary care. In this observational study, patients prescribed medications, particularly muscle relaxants, reported less severe symptoms after 1 week than those receiving no medications. However, randomized trials are needed to determine which medication or combinations of medications are most effective.
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Comparative Study
Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging.
In vivo flexion-extension magnetic resonance imaging studies of the cervical spine were performed inside a positioning device. ⋯ Compared with the results of previous studies using functional cervical myelograms, kinematic magnetic resonance imaging provides additional noninvasive data concerning the physiologic changes of the cervical subarachnoid space and the cervical cord during flexion and extension in healthy individuals.
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Biography Historical Article
Historical perspective. Ernest Amory Codman, 1869-1940. A pioneer of evidence-based medicine: the end result idea.
Unappreciated during his career and largely uncelebrated today, Ernest A. Codman made profound contributions to medical practice and outcomes research. ⋯ Codman's ideas, courage, and persistence played a critical role in the transition from the 19th century artisan style of medical practice to the current scientific basis of medicine. This historical perspective is a tribute to Codman's contributions to medical science and highlights his remarkable career.