Spine
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Comparative Study Clinical Trial Controlled Clinical Trial
Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion.
A prospective study of 87 patients who underwent unilateral or bilateral pedicle screw fixation. ⋯ Unilateral pedicle screw fixation was as effective as bilateral pedicle screw fixation in lumbar spinal fusion independent of the number of fusion segments (one or two segments) or pedicle screw systems. Based on the results of this study, unilateral fixation could be used in two-segment lumbar spinal fusion.
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Clinical Trial Controlled Clinical Trial
Can discography cause long-term back symptoms in previously asymptomatic subjects?
A prospective controlled study of patients without low back pain observed after experimental lumbar discography. ⋯ Discography in a subject group without low back pain but with significant emotional and chronic pain problems may result in reports of significant back pain for at least 1 year after injection. Subjects with normal psychometric test results had no reports of significant long-term back pain after discography.
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Review of the clinical and radiologic records of patients who underwent one-level posterior lumbar interbody fusion (PLIF) at L4-L5. ⋯ There is no evidence from the results that postoperative narrowing of the adjacent disc and preoperative narrowing of the L5-S1 disc affects the clinical outcome of L4-L5 PLIF.
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A retrospective follow-up study was conducted in patients who underwent decompressive laminectomy for degenerative lumbar spinal stenosis. ⋯ Long-term follow-up showed that even without spinal fusion, more than half the patients were evaluated as excellent or good. Patients with more than a 10 degrees sagittalrotation angle who need multiple laminectomy, should be given information about the possibility of earlier deterioration of the outcome, and alternative or additional treatment such as concomitant spinal fusion with decompression may be considered.
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Traditional approaches to thoracic metastases and spinal cord compression have been well worked out and validated in the literature. Anterior decompression is clearly superior to laminectomy; vertebrectomy and reconstruction are indicated for sagittal collapse, instability, and pain; and surgical decompression is necessary in cases of bony impingement. The role of endoscopic and minimally invasive techniques in treatment of metastatic disease is evolving. ⋯ Lieberman advocates the use of thoracoscopic anterior approaches as the principal application in these patients, whereas Dr. McLain has found that endoscopic assistance has vastly improved his results with posterolateral decompression. The two authors weigh the relative advantages and disadvantages of these approaches for the selected patient with metastatic thoracic disease.