Spine
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Galen of Pergamum AD (2nd century), the most eminent Greek physician after Hippocrates, marked the history of medicine for more than 14 centuries. His doctrines, expressed in his voluminous work, combined the medical heritage of the Hippocratic, the Alexandrian, and some of the most important medical schools of antiquity. The strong influence of the Hippocratic tradition can characteristically be traced in orthopaedics and particularly in Galen's presentation of the spine. ⋯ Galen was the first physician to demonstrate the neurological implications following transection of the spinal cord at several levels. The predominant feature in Galen's reference to spine is its teleological perspective; the great physician tended to attribute the prodigious structure of the spine to nature's providence. Despite the inevitable anatomical errors, Galen's inspired experiments remained the only thorough approach of spinal anatomy and pathology until the recent centuries, when the evolution of sophisticated technical aids opened new pathways to spine research.
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In this prospective study, the results of treating unstable thoracolumbar and lumbar injuries with Cotrel-Dubousset instrumentation were investigated. ⋯ Cotrel-Dubousset instrumentation provided spinal stability in unstable injuries, forming a rigid construct and restoring physiologic thoracolumbar and lumbar postural contours because of its highly corrective effect in the sagittal profile with no loss of correction.
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A retrospective, follow-up study. ⋯ The long-term results of standard lumbar discectomy are not very satisfying. More than one-third of the patients had unsatisfactory results and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level were negative predictors of a good outcome. These indicators should be used preoperatively to identify patients who are at high risk for an unfavorable long-term result.
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This retrospective study was conducted to analyze the clinical results in 30 patients with cervical kyphosis that had been treated using cervical pedicle screw fixation systems. ⋯ Cervical kyphosis in 30 patients was effectively corrected using a pedicle screw fixation procedure with no serious complications. Flexible kyphosis with segmental motion can be satisfactorily corrected by a single posterior procedure using pedicle screw fixation. However, circumferential osteotomies combined with a posterior shortening procedure involving a pedicle screw system are required to achieve the best correction of fixed kyphosis by bony union. Cervical pedicle screw fixation is the most advantageous instrumentation in the correction of cervical kyphosis.
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The vertebral levels of dorsal root ganglia innervating the dorsal portion of the L5-L6 intervertebral disc were investigated in rats using a retrograde transport method. The pathways and functions of nerve fibers supplying the dorsal portion of the disc were determined by denervation and immunohistochemistry. ⋯ The dorsal portion of the L5-L6 disc of rats was shown to be multisegmentally innervated by the T13 to L6 dorsal root ganglia. The sensory fibers from T13, L1, and L2 dorsal root ganglia were shown to innervate the dorsal portion of the L5-L6 disc through the paravertebral sympathetic trunks. In contrast, those from the L3-L6 dorsal root ganglia may innervate the dorsal portion of the L5-L6 disc through the sinuvertebral nerves.