Spine
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Facet joint kinematics and capsular ligament strains were evaluated during simulated whiplash of whole cervical spine specimens with muscle force replication. ⋯ Facet joint components may be at risk for injury due to facet joint compression during rear-impact accelerations of 3.5 g and above. Capsular ligaments are at risk for injury at higher accelerations.
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Cervical spine injury related to motor vehicle collision (MVC) is a severe and often permanently disabling injury. Although advances in automobile crashworthiness have reduced both fatalities and some severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on cervical spine injury is unknown. ⋯ The results of this study suggest that there is an increase in overall protection against cervical spine injury by combining airbag and seatbelt restraint systems relative to seatbelt alone.
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Comparative Study
Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine.
In vitro comparison of four reconstruction techniques following transforaminal lumbar interbody fusion in a human cadaveric model. ⋯ TLIF reconstruction with a solitary cage did not increase overall spine flexibility from the intact condition but significantly increased segmental flexibility at L4-L5 in axial rotation. A unilateral translaminar facet screw had minimal stabilizing effect at L4-L5. Unilateral pedicle screws frews further increased stiffness at the L4-L5 segment. However, TLIF with bilateral pedicle screws most closely approximated the L4-L5 segmental flexibility of the intact spine.
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The literature regarding surgical treatment's impact on patient function after spinal fracture is sparse. Some authors have speculated that operative injury--the dissection of paraspinous muscle tissue, damage to spinal motion segments, implantation of spinal devices--may impair functional recovery in spine trauma patients. Nonoperative care has produced satisfactory results in some hands, but results are difficult to reproduce, treatment is resource-intensive, and functional outcomes are poorly documented. This study reports return to work and functional recovery in a 5-year follow-up of severely injured patients treated with segmental spinal instrumentation. ⋯ Neurologic injury had a greater impact on functional outcome than any other variable. Patients limited by pain were more often impaired by residual radicular and neuropathic symptoms than by back pain. Impairment was not related to the extent of either the surgical incision or the instrumentation. Patients with persistent back pain generally had an identifiable and correctable mechanical problem-sagittal imbalance, pseudarthrosis, or persistent instability--as the underlying cause. Our series of trauma patients was predominantly young and male. Among this cohort, individual characteristics of occupation (often physical laborers and craftsmen) and judgment (criminal convictions and incarceration) may have restricted opportunities for re-employment in 40% of the entire study group.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group.
A cost-effectiveness study was performed from the societal and health care perspectives. ⋯ For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.