Spine
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We propose that chronic spondylolytic defects at L5 are influenced by insufficient differential mediolateral distances between inferior articular facets of L4 and the superior facets of S1, which results in these structures impinging on adjacent sides of the par interarticularis during hyperlordosis. Individuals with adequate increase in interfacet distances from L4 through S1 are less likely to develop or maintain defects. ⋯ Spondylolysis is the direct result of contact pressures on both sides of the pars interarticularis resulting from inadequate separation between the inferior articular processes of L4 and the superior articular facets of S1. Individuals lacking sufficient increase in transverse interfacet dimensions in their lumbar columns are at greater risk of developing and maintaining spondylolytic defects.
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Review Case Reports
Sacral insufficiency fractures following multilevel instrumented spinal fusion: case report.
Case series. ⋯ Patients who complain of new-onset buttock pain following multilevel lumbar-sacral fusion with instrumentation should be evaluated for sacral insufficiency fractures, especially if they have been sitting for prolonged periods. Conservative treatment seems to be sufficient.
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Comparative Study
Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques.
Data were derived from a randomized controlled trial on the (cost-) effectiveness of the implementation of the clinical guidelines on physiotherapy for low back pain in primary care. ⋯ A substantial proportion of patients still experienced some pain and disability at 12 months follow-up. The most stable predictor of prognosis in low back pain was the duration of the current episode. The choice of statistical method influenced the final model; however, changes in the explained variance were small.
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Whole cervical spine model with muscle force replication was subjected to simulated frontal impacts of increasing severity, and resulting injuries were evaluated via flexibility testing. ⋯ Middle (C2-C3 to C4-C5) and lower (C6-C7 and C7-T1) cervical spine were at risk for injury during frontal impacts, for the experimental conditions studied.
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Prospective cohort study. ⋯ Principles of wide surgical resection, commonly applied in appendicular oncology, can and should be used for the treatment of primary bone tumors of the spine with anticipated acceptable morbidity and satisfactory survival.