Spine
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The cost of chronic benign spinal pain is large and growing. The costs of interventional treatment for spinal pain were at a minimum of $13 billion (U. S. dollars) in 1990, and the costs are growing at least 7% per year. ⋯ Cost-minimization versus cost-effectiveness approaches are described. Spinal cord stimulation and intraspinal drug infusion systems are alternatives that can be justified on a cost basis. Cost minimization analysis suggests that epidural injections under fluoroscopy may not be justified by the current literature.
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A prospective longitudinal study was conducted to evaluate dysphagia after anterior cervical spine surgery. ⋯ Dysphagia after anterior cervical spine surgery is a common early finding. However, it decreases significantly by 6 months. The minority of patients experience moderate or severe symptoms by 6 months after the procedure. Female gender and multiple surgical levels could be identified as risk factors for the development of postoperative dysphagia.
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A clinical prospective observational cohort study of 15 patients undergoing cervical intervertebral disc replacement. ⋯ Cervical intervertebral motion can be maintained with the new device, which is clinically stable. Meticulous attention must be paid to the surgical technique to maximize the chances of a good result. The pilot study was successful, although it has yet to be determined what conditions will benefit most from this technology.
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The literature on diagnostic tests available to the spine clinician for the evaluation of chronic low back pain was reviewed. ⋯ There are inherent limitations in the accuracy of all diagnostic tests. The tests used to diagnose the source of a patient's chronic low back pain require accurate determination of the abolition or reproduction of the patient's painful symptoms.
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Comparative Study
Biomechanical testing of posterior atlantoaxial fixation techniques.
An in vitro biomechanical study of C1-C2 posterior fusion techniques was conducted using a cadaveric model. ⋯ The results clearly indicate the screw-rod system's equivalence in reducing relative atlantoaxial motion in a severely destabilized upper cervical spine, as compared with the transarticular screw-wiring construct. These findings mirror the previously reported clinical results attained using this new screw-rod construct. Thus, the decision to use either screw construct should be based on safety considerations rather than acute stability.