Spine
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Comparative Study Guideline
Updated method guidelines for systematic reviews in the cochrane collaboration back review group.
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A case report of a patient with a congenital anomaly of the posterior arch of the atlas and review of the literature are reported. ⋯ This case illustrates a symptomatic congenital deformity of the posterior arch of the atlas due to a mobile, isolated fragment. These anomalies are exceedingly rare. To date, only 17 patients, including ours, have been described in the literature as having myelopathy related to an isolated posterior tubercle. Of these, only two patients had documented movement of this tubercle before our report. Recognizing the anomaly is crucial because treatment is relatively simple, produces resolution of symptoms, and prevents major neurologic deficits from occurring after trauma.
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Comparative Study Clinical Trial
Standing lateral radiographic positioning does not represent customary standing balance.
Normal cohort evaluation of the accuracy of existing methods for radiographic measurement of sagittal spinal balance. ⋯ Measurement of the sagittal vertical axis on radiographs from commonly utilized standing positions (shoulders flexed) results in an sagittal vertical axis that is at least 3 to 4 cm more posterior than a sagittal vertical axis observed during a functional position. Subject repositioning resulted in an intertrial variability of at least 0.8 cm in sagittal vertical axis, while variation as the subject held each standing posture had little contribution to overall error of measurement. Of the analyzed positions, shoulder flexion (45 degrees ) alone was the best position for a lateral radiograph due to minimal compromise to repeatability of sagittal vertical axis measurement. However, none of the radiographic positions reproduced the spinal balance of the subject's functional standing posture.
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The seat and back contact force, pressure distribution, lumbar lordosis, and low back muscle activities associated with a new seat design with adjustable ischial support and backrest were investigated using kinematic, kinetic, electromyographic, and radiographic measurements. ⋯ Sitting with reduced ischial support and fitted backrest to the lower spine altered the contact area, reduced peak pressure under the ischia, reduced muscular activity, maintained total and segmental lumbar lordosis, rotated the sacrum forward, and increased lumbar intervertebral disc heights, which could potentially reduce low back pain.
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A case report of distant discitis and vertebral osteomyelitis involving skip levels after caudal epidural steroid injection. ⋯ Distant discitis and vertebral osteomyelitis involving skip levels and without the occurrence of epidural abscess formation is a serious but rare complication after epidural injection.