Spine
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Randomized Controlled Trial Comparative Study
A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium.
A prospective randomized clinical trial in preemptive analgesia for postoperative pain was conducted. ⋯ DS provided a favorable effect immediately after surgery, but the effective time was short and the patient needed more supplemental drugs after that. ED did not give the expected effect, with comparatively high rates of side effects. Continuous epidural anesthesia did not seem to be suitable for preemptive analgesia. Continuous subcutaneous morphine brought some analgesic effects with a low rate of complications. It can be an attractive method for postoperative analgesia with technical ease.
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Correlation study. ⋯ The implementation of multidisciplinary, nonsurgical spine clinics coincided closely with a significant reduction in the rate of lumbar disc surgery. The observed reduction seems most likely to be causally associated with educational activities and improved patient care provided by the clinics.
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A prospective evaluation of the effects of backpack carriage on the pulmonary function of schoolgirls without spinal deformity versus those with adolescent idiopathic scoliosis (AIS). ⋯ Pulmonary function may be more sensitive to backpack load than previously considered, especially when study participants with AIS are being considered, and the recommended loading limit of 10% body weight may not be applicable to schoolgirls with AIS.
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Comparative Study
A comparison of pedicle and lateral mass screw construct stiffnesses at the cervicothoracic junction: a biomechanical study.
Biomechanical comparison of five different posterior cervicothoracic junction (C7-T1) fixation constructs in a cadaveric model. ⋯ C7 pedicle screw fixation provides the construct with the highest normalized stiffness for stabilizing the cervicothoracic junction. If C7 pedicle fixation is not possible, then performing two-level lateral mass fixation at C6 and C7 will achieve a construct with similar normalized stiffness except in axial compression. The addition of triple wiring to the spinous processes does not significantly increase lateral mass construct normalized stiffness.
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A retrospective review of 33 consecutive patients treated with posterior fusion and selective nerve root decompression for the treatment of pseudarthrosis following anterior cervical discectomy and fusion. ⋯ This is the first study to our knowledge to use standardized outcome measures to assess clinical outcome in patients treated with posterior fusion for pseudarthrosis after anterior cervical discectomy and fusion. Patients and surgeons need to understand the potential for success with this revision procedure but also be aware of the relatively high rate of continued moderate to severe pain observed in this patient population even after a solid fusion is achieved. All of the patients in this study fused with a single posterior fusion procedure, further supporting the relatively higher fusion rates observed in the literature using posterior fusion as a treatment for cervical pseudarthrosis. Our results also support the ability of surgeons to use local bone graft without iliac crest in a posterior fusion for cervical pseudarthrosis and therefore avoid the morbidity associated with iliac crest bone graft harvest.