Spine
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Randomized Controlled Trial
Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.
A prospective clinical randomized controlled trial. ⋯ Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
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Case Reports
Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament.
Case report. ⋯ Ossification of various parts of the spinal ligament have been reported previously. Among them, ossification of both the PAAM and TAL has never been reported previously and is thus extremely rare. Surgical intervention improved the neurological impairment.
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Comparative Study
Comparison of Healos/bone marrow to INFUSE(rhBMP-2/ACS) with a collagen-ceramic sponge bulking agent as graft substitutes for lumbar spine fusion.
A rabbit lumbar intertransverse process arthrodesis model was used to evaluate the efficacy of two different bone substitute materials: 1) collagen-hydroxyapatite sponge (Healos bone void filler) combined with heparinized bone marrow; and 2) recombinant human bone morphogenetic protein-2 delivered in a collagen sponge (INFUSE Bone Graft) wrapped around an additional collagen-ceramic sponge (Mastergraft Matrix) as a "bulking agent." ⋯ From the manual palpation, radiographic and biomechanical assessment of fusion, the results in this study showed that INFUSE (rhBMP-2/collagen sponge) consistently produced spine fusion when wrapped around a collagen-ceramic sponge bulking agent (Mastergraft Matrix). Meanwhile, Healos was ineffective as a bone graft material when combined with heparinized autogenous bone marrow.
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Spinal ependymoma is a benign central nervous system tumor described as an intramedullary lesion more frequently located at the conus medullaris. It has been described exceptionally in the literature as an intradural extramedullary tumor. ⋯ All of the previously reported cases of spinal intradural extramedullary ependymomas carried out a benign course. The case we are reporting is the first one in which malignant transformation occurred. This tumor should be taken into account in the differential diagnosis of intradural extramedullary lesions. Moreover, close follow-up is recommended for this unusual location of ependymomas.
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Cross-sectional analysis of analgesic use by patients with low back pain (LBP). ⋯ With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services.