Spine
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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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Case Reports
Multimodality management of a giant cell tumor arising in the proximal sacrum: case report.
Descriptive. ⋯ A novel multimodality approach, consisting of resection, controlled cryosurgery, and a unique lumbopelvic reconstruction, was safe and successful in managing a challenging proximal sacral giant cell tumor. Twenty months after surgery the patient has excellent bowel and bladder control, no tumor recurrence, and functional ambulation without a brace or pain.
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Clinical Trial
Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment.
A prospective study of 22 patients with the syndrome of acute central cervical spinal cord injury with motor and sensory impairment involving only upper extremities (ACCSCI-U) was done from admission to the 2-year follow-up. ⋯ In patients with ACCSCI-U, a favorable neurologic prognosis can be predicted following nonsurgical treatment. Most recovery occurred by 6 weeks, and patients with severe initial neurologic damage and old age had poorer recovery. Touch and pin sensation recovered at the same rate, whereas motor recovered more quickly. The absence of abnormal MRI signal intensity in the spinal cord and a good early neurologic improvement were the significant predictors of long-term improvement in neurologic function.
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A case-control retrospective analysis comparing patients who developed a postoperative spinal epidural hematoma with patients who did not develop this complication. ⋯ Patients who require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk for developing a postoperative epidural hematoma.
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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.