Spine
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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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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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Case series. ⋯ The procedure may be less effective when performed by a variety of providers than suggested by initial case series performed by single providers or practices in work-related LBP cases. Provider self-referral and narcotic use before IDET are significant risk factors for poor outcomes. Randomized controlled trials are needed to determine whether there is a subset of patients with discogenic back pain who derive substantial and sustained benefit from this procedure.
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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.
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Randomized Controlled Trial Clinical Trial
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial.
A randomized controlled trial with stratified block design. ⋯ An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy.