Spine
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Eight patients with a herniated disc after lumbar spinal fusion are reported. Their clinical features, imaging studies, and management are reported. ⋯ Herniated disc after lumbar spinal fusion was found in approximately 1.3% of patients. Although rare, this entity that should be considered when patients complain of recurring back pain after a lumbar spinal fusion.
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Case Reports
Degenerative disc disease treated with combined anterior and posterior arthrodesis and posterior instrumentation.
This study retrospectively reviewed the outcome of 58 patients all diagnosed with severe low back pain secondary to degenerative disc disease and treated with anterior arthrodesis and posterior instrumented arthrodesis. ⋯ Selected patients with discography-proven severe low back pain secondary to degenerative disc disease, who failed extensive nonoperative treatment, were treated successfully with anterior-posterior instrumented arthrodesis. The good arthrodesis rate, return to work rate, and patient satisfaction may justify the consideration of this aggressive treatment option in this specific patient population.
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An electrophysiologic study to examine effects of exogenous application of tumor necrosis factor-alpha (TNF-alpha ) activities and nociresponses of dorsal horn neurons in the spinal cord at L5. ⋯ These results suggest the possibility that TNF-alpha produced in the vicinity of nerve roots due to disc herniation might cause ectopic discharges in primary afferent fibers and thereby induce the prolonged excitation in pain-processing neurons responsible for radicular pain.
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Comparative Study
Biomechanical analysis of biodegradable interbody fusion cages augmented With poly(propylene glycol-co-fumaric acid).
Three different types of biodegradable poly(L-lactide-co-D,L-lactide) cages with and without augmentation of a biodegradable poly(propylene glycol-cofumaric acid) scaffold were compared with autograft and metallic cages of the same design and size by determining the stiffness and failure load of the L4-L5 motion segment of cadaveric human spines. ⋯ By comparison, the in vitro lumbar spinal motion segment stiffness and failure load produced by implantation of a biodegradable interbody fusion cage augmented with an expandable PPF scaffold is similar to that of the titanium BAK cage. This suggests that biodegradable anterior interbody fusion systems could be further developed for clinical applications.
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Randomized Controlled Trial Clinical Trial
The association between cervical rib and sacralization.
After determining the normal reference values for the length of the transverse processes of the seventh cervical vertebra, the association between the presence of cervical rib and sacralization was investigated. ⋯ Presence of cervical rib might be a clue to the existence of sacralization or vice versa. In patients with cervical or lumbar pain, this association may be helpful for differential diagnosis before applying sophisticated diagnostic techniques.