Spine
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Randomized Controlled Trial Clinical Trial
A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome.
In a randomized, double-blind study, two dosage strengths of botulinum toxin type A were compared with normal saline injected into symptomatic trigger points in the cervicothoracic paraspinal muscles. ⋯ Although no statistically significant benefit of botulinum toxin type A over placebo was demonstrated in this study, the high incidence of patients who were asymptomatic after a second injection suggests that further research is needed to determine whether higher dosages and sequential injections in a larger cohort might show a botulinum toxin type A effect.
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Comparative Study
A comparison of magnetic resonance and computed tomographic image quality after the implantation of tantalum and titanium spinal instrumentation.
Tantalum- and titanium-based lumbar interbody fusion devices were implanted into two fresh human cadavers, and magnetic resonance and computed tomographic imaging were performed to evaluate adjacent spinal structures and the amount of metallic artifact. ⋯ High-quality magnetic resonance imaging studies can be obtained after the implantation of both titanium and tantalum spinal instrumentation. Both of the metals produce similar images on magnetic resonance imaging studies with comparable amounts of metallic artifact. High-quality computed tomographic scans of titanium implants can be obtained with minimal distortion secondary to artifact. However, computed tomographic scanning is not the imaging modality of choice for the tantalum spinal implants because of the large amounts of artifact.
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The biomechanical influence of in situ setting hydroxyapatite cement was examined for use in pedicle screw revision surgery. Pull-out testing of control and pedicle screws augmented with hydroxyapatite cement was performed in human cadaver vertebrae. ⋯ Hydroxyapatite cement may be a mechanically viable alternative to polymethyl methacrylate for augmenting revision pedicular instrumentation and should be considered for future experimental, animal, and clinical testing.
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Directions of the C1-C2 posterior transarticular screw trajectories making the longest path or violating the transverse foramen were measured by using an objective measuring method. ⋯ The areas on the superior articular surface of C2 intersected by the trajectories making the longest paths without violating the transverse foramen are clarified as a guide to the ideal and safe trajectories. The theoretical minimal risk and usual risk of the posterior C1-C2 transarticular screw fixation are presented as well.