Spine
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Retrospective cohort study using national sample administrative data. ⋯ Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications.
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Prospective study with patient and physician questionnaires, clinical records, and imaging. ⋯ Despite clear average improvement, surgeons tended to give overly optimistic predictions that were not correlated with patient outcome. For patients receiving a treatment not meeting explicit criteria of appropriateness, more optimistic physician expectation was associated with better improvement of psychological dimensions. Besides prognostic ability, the influence of physician expectation on patient outcome is discussed and the concept of "curabo effect" (differentiated from "placebo effect") proposed.
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Comparative Study
Biomechanical comparison of lumbosacral fixation using Luque-Galveston and Colorado II sacropelvic fixation: advantage of using locked proximal fixation.
Biomechanical evaluation of sacropelvic fixation strategies as they apply to neuromuscular scoliosis. ⋯ The 2 methods of sacropelvic fixation provided similar construct stiffness, although the Colorado II method had less L5-S1 motion on flexion-extension testing, and the Galveston construct tended (although not statistically) to be stiffer in torsional loading. The addition of a pair of L1 pedicle screws increased the construct stiffness for both constructs by approximately 50%.
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Retrospective radiographic and chart review. ⋯ The radiographic ROM at 8.6-year follow-up was positively correlated with several outcomes measures. Patients with motion > 5 degrees had clinically modest but statistically better outcomes in ODQ and modifiedStauffer-Coventry scores. Longer follow-ups will be necessary to measure fully the impact of TDR ROM on outcome.
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Descriptive. ⋯ This is an unusual presentation of an expanding intra-abdominal mass originating from the lumbar spine during pregnancy. It most likely represents rapid growth of a previous unrecognized recurrence of a GCT. Close observation and follow-up CT scanning are imperative to identify and treat GCTs of the spine before rapid growth occurs.