Spine
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Comparative Study
Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures.
A retrospective study using two independent, blinded musculoskeletal radiologists to evaluate the sensitivity, specificity, and predictive value of cervical spine magnetic resonance imaging in detecting posterior element fractures of the cervical spine. ⋯ Magnetic resonance imaging was not effective in recognizing bony injury to the cervical spine and in particular was not as sensitive or as specific as computed tomography in identifying cervical spinal fractures. Computed tomography remains the study of choice for the detection and precise classification of bony injuries to the cervical region, especially when plain radiographs are difficult to evaluate. Magnetic resonance imaging, although not as effective as computed tomography in defining specific bony disorders, remains the gold standard in the evaluation of spinal cord injury, occult vascular injury, and intervertebral disc disruption (hyperextension injury), including herniation and other soft tissue disorders (hematoma, ligament tear).
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Comparative Study
Markers of nerve tissue injury in the cerebrospinal fluid in patients with lumbar disc herniation and sciatica.
The light subunit of neurofilament protein, S-100 protein, neuron-specific enolase, and glial fibrillary acidic protein were determined in the cerebrospinal fluid in patients with lumbar disc herniation and in control patients. ⋯ Patients with disc herniation and sciatica have increased concentrations of neurofilament protein and S-100 in the cerebrospinal fluid, which indicates damage of axons and Schwann cells in the affected nerve root.
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A prospective, consecutive study of patients' outcome at three subsequent follow-up times after lumbar disc surgery. ⋯ Patients whose outcome after lumbar disc surgery does not remain stable present a major problem in the calculation of prognostic factors.
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Comparative Study
Contralateral recurrent lumbar disc herniation. Results of discectomy compared with those in primary herniation.
The surgical outcomes of patients who underwent discectomy for contralateral recurrent herniation and primary herniation were evaluated. ⋯ Clinical results in patients reoperated on for contralateral recurrent lumbar disc herniation compare favorably with those reported after primary discectomy. The improvement of pain in the low back and lower limbs reported by the majority of patients 2 years after reoperation suggests that fusion is not needed in this patient population.
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Potential precipitating events and risk factors for vertebrobasilar artery dissection were reviewed in an analysis of the English language literature published before 1993. ⋯ The literature does not assist in the identification of the offending mechanical trauma, neck movement, or type of manipulation precipitating vertebrobasilar artery dissection or the identification of the patient at risk. Thus, given the current status of the literature, it is impossible to advise patients or physicians about how to avoid vertebrobasilar artery dissection when considering cervical manipulation or about specific sports or exercises that result in neck movement or trauma.