Spine
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial.
A randomized clinical trial was conducted. ⋯ For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.
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Clinical Trial Controlled Clinical Trial
Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications.
A two-part investigation was conducted: 1) a prospective study of asymptomatic subjects quantitatively comparing trunk mobility to surface electromyographic (sEMG) signals from the erector spinae during trunk flexion; and 2) a prospective repeated-measures cohort study of patients with chronic disabled work-related spinal disorder tested for the flexion-relaxation (FR) phenomenon while measured simultaneously for lumbar spine inclinometric range of motion (ROM). ⋯ Flexion-relaxation measures a point at which true lumbar flexion ROM approaches its maximum in asymptomatic subjects. This also is the point at which lumbar extensor muscle contraction relaxes, allowing the lumbar spine to hang on its posterior ligaments. The gluteal and hamstring muscles then lower the flexed trunk even further by allowing the pelvis to rotate around the hips. This phenomenon was subsequently found in Part 2 to offer a potentially promising method for individualizing rehabilitation treatment, decreasing unnecessary utilization, identifying potential postrehabilitation treatment failures, and assessing permanent impairment rating validity. Moreover, this is the first study to demonstrate systematically that an absence of FR in patients with chronic low back pain can be corrected with treatment.
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Review Case Reports
Vertebral body ischemia in the posterior spinal artery syndrome: case report and review of the literature.
A case of posterior spinal cord syndrome in which magnetic resonance images showed predominant T2 hyperintense signal in the adjacent vertebral body is reported. ⋯ Associated bone marrow abnormalities likely reflect the underlying pathology of the blood supply to the vertebral body, and may be an additional key sign for radiologic diagnosis of posterior spinal cord syndrome.
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A retrospective cohort study was conducted. ⋯ At a minimum follow-up evaluation of 10 years, lumbar fusion with pedicle screw fixation showed relatively good functional capacity, especially relative to the baseline, a low rate of radiographic failure, satisfaction of patients with their progress, a low rate of repeat surgery, and minimal surgical and hardware-related complications.
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A retrospective study investigated the sagittal alignment in adolescent idiopathic scoliosis (AIS). ⋯ Thoracic kyphosis depended mostly on the spinal deformity, whereas lumbar lordosis was influenced mainly by the pelvic configuration. The scoliotic curve type was not associated with a specific pattern of sagittal pelvic morphology and balance. The pelvic incidence found in this study was significantly higher than that reported in the literature for normal adolescents. The role of the pelvic incidence in the pathogenesis of adolescent idiopathic scoliosis needs to be explored in a longitudinal study involving patients with adolescent idiopathic scoliosis and normal adolescents.