Spine
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Randomized Controlled Trial Clinical Trial
Can it be predicted which patients with chronic low back pain should be offered tertiary rehabilitation in a functional restoration program? A search for demographic, socioeconomic, and physical predictors.
A prospective clinical trial was conducted that involved six groups of patients with chronic low back pain selected from a large cohort (N = 816). ⋯ Different factors can be identified as predictive of outcome in a functional restoration program, but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment.
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Case Reports Comparative Study
Acute nontraumatic spinal epidural hematomas. An important differential diagnosis in spinal emergencies.
The clinical data of five patients with spontaneous spinal epidural hematoma (SSEH) were reviewed. ⋯ The results of the current series demonstrate both the superiority of magnetic resonance imaging for diagnosis of SSEH as well as the necessity of early decompressive surgery in cases of sensorimotor paralysis after SSEH.
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Comparative Study
Dynamic motion study of the whole lumbar spine by videofluoroscopy.
Dynamic lumbar flexion-extension motion was assessed by videofluoroscopy. ⋯ Segmental instability influences the whole lumbar motion in patients with degenerative spondylolisthesis. The patients with chronic low back pain did not show a significant difference when compared with the volunteers.
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Sagittal alignments, including lumbar lordosis and spinopelvic balance (measured from C7, S1, and hip axis reference points for the relative positions of the spine and sacropelvis over the hips), were studied on standing 36-in. lateral radiographs of adult volunteers (control subjects) and patients who had specific spinal disorders. ⋯ Lower lumbar lordosis, by the pelvic radius technique, and compensatory sacropelvic translation around a hip axis, in addition to measurements from this axis to the C7 plumb line, were the primary determinates and most reliable radiographic assessments for sagittal balance. Understanding the common and characteristically different compensations that occur with balance in these patients who had specific spinal disorders may help to improve their care.
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Video fluoroscopy was used to evaluate the motion in an unstable spine during helmet and shoulder pad removal. ⋯ Helmet and shoulder pad removal in the unstable cervical spine is a complex maneuver. In the unstable C1-C2 segment, helmet removal causes more angulation in flexion, more distraction, and more narrowing of the space available for the cord. In the lower cervical spine (C5-C6), helmet removal causes flexion of 9.32 degrees, and during shoulder pad removal the neck extends 8.95 degrees, a total of approximately 18 degrees. Disc height changes from 1.24 mm of distraction to 1.06 mm of compression during helmet removal and shoulder pad removal for a total 2.3-mm change. Translation, which correlates with the change in the space available for the cord, is greater at C5-C6 during shoulder pad removal. Because most of the cadavers had C5 anteriorly displaced on C6 to begin with, the extension force during shoulder pad removal caused a 3.87-mm change in reduction of C5 on C6. Because of the motion observed in the unstable spine, helmet and shoulder pad removal should be performed in a carefully monitored setting. They should be removed together by at least three, preferably four, trained people.