Spine
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A technique for posterior cervical hemilaminectomy reconstruction is described. ⋯ The advantages of this technique are restoration of normal anatomy, technical ease, and simplicity. A modification of this technique in children by using absorbable rather than metal plates should allow for normal spine growth.
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A retrospective review of all the surgically managed spinal fractures at the University of Missouri Medical Center during the 41/2-year period from January 1989 to July 1993 was performed. Of the 51 surgically managed patients, 46 were instrumented by short-segment technique (attachment of one level above the fracture to one level below the fracture). The other 5 patients in this consecutive series had multiple trauma. These patients were included in the review because this was a consecutive series. However, they were grouped separately because they were instrumented by long-segment technique because of their multiple organ system injuries. ⋯ The Load-Sharing Classification is a straightforward way to describe the amount of bony comminution in a spinal fracture. When applied to patients with isolated spine fractures who are cooperative with 3 to 4 months of spinal bracing, it can help the surgeon select short-segment pedicle-screw-based fixation using the posterior approach for less comminuted injuries and the anterior approach for those more comminuted. The choice of which fracture-dislocations should be strut grafted anteriorly and which need only posterior short-segment pedicle-screw-based instrumentation also can be made using the Load-Sharing Classification.
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The literature on psychological factors in neck and back pain was systematically searched and reviewed. ⋯ Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
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Population-based, cross-sectional mailed survey. ⋯ This study suggests that important associations exist between comorbidities, a past history of neck injury resulting from a motor vehicle collision, and graded neck pain. Importantly, individuals who are significantly disabled by neck pain also have comorbidities that have a moderate or severe impact on their health, suggesting that chronic disorders tend to cluster in some individuals.