Spine
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An in vitro biomechanical study of various reconstructive techniques following decompression of the spondylotic cervical spine. OBJECTIVE.: To evaluate the biomechanical stability of anterior cervical plate fixation following three strategies of decompression for multilevel cervical spondylosis (three levels) of the cervical spine: three level discectomy, single corpectomy and discectomy, and a two-level corpectomy. ⋯ Cervical myelopathy is traditionally treated with a multilevel corpectomy and an end-construct plate fixation spanning the strut graft. A large moment arm is generated at the ends of the construct, potentially leading to plate migration or dislodgment. Often times, adequate decompression can be achieved with either a multilevel discectomy or a combined discectomy and corpectomy with segmental plate fixation. This study clearly demonstrates that segmental plate fixation affords a more biomechanically rigid method of reconstruction with regards to flexion-extension and lateral bending than end-construct plate fixation. The increased rigidity afforded by segmental fixation may significantly decrease the likelihood of plate dislodgement in the setting of anterior instrumentation alone following anterior alone, long segment reconstruction procedures.
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Patients completing a multidisciplinary pain treatment were contacted to obtain 13-year follow-up information on pain, mood, employment, and general health. ⋯ The data lend support to the long-term effectiveness of multidisciplinary treatment programs for chronic low back pain.
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A retrospective review of 303 MRI scans of the lumbar spine was conducted. ⋯ Both anterior and posterior lumbar facet joint synovial cysts are rare. Posterior cysts are more common than anterior cysts. Both types of cysts are related to facet joint osteoarthritis but not to disc disease.
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Case Reports
Acute noncontiguous multiple-level thoracic disc herniations with myelopathy: a case report.
The case report of a 38-year-old man with a unique acute, triple-level, noncontiguous thoracic disc herniation (T6, T9-T10, and T11-T12), delayed onset of lower limb weakness, paresthesias below the T10 dermatome, and urinary dysfunction following minor trauma resulting from a motorcycle accident. ⋯ Since the presentation of thoracic disc herniation is variable and difficult to correlate with imaging findings, decompression at all lesion levels in a patient with symptomatic multiple-level ruptured thoracic disc herniations may be necessary to achieve complete symptom relief and satisfactory results.
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Kinematics of the upper cervical spine during head rotation were investigated using three-dimensional magnetic resonance imaging (MRI) in healthy volunteers. ⋯ We developed an innovative in vivo three-dimensional motion analysis system using three-dimensional MRI. In vivo coupled motions of the upper cervical spine investigated using this system supported the results of the previous in vitro study.