Spine
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Randomized Controlled Trial Multicenter Study Comparative Study
Initial fusion rates with recombinant human bone morphogenetic protein-2/compression resistant matrix and a hydroxyapatite and tricalcium phosphate/collagen carrier in posterolateral spinal fusion.
Prospective, randomized, unblinded study of iliac crest bone graft (ICBG) versus recombinant human bone morphogenetic protein-2/compression resistant matrix (rhBMP-2/CRM)in a posterolateral instrumented fusion procedure. ⋯ These early results are encouraging and suggest a more rapid incorporation and development of the fusion mass with rhBMP-2/CRM than iliac crest autograft in a single level posterior instrumented fusion.
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Multicenter Study Comparative Study
The transition from acute to subacute and chronic low back pain: a study based on determinants of quality of life and prediction of chronic disability.
Follow-up study. ⋯ LBP influences disability and quality of life more than RP. Disability is predicted by pain duration and quality of life is predicted by disability, but pain severity predicts neither one of them. Changes related to determinants of disability and quality of life, and to the prediction of chronic disability, appear 14 days after the onset of pain, supporting that cutoff point for considering a patient as being subacute.
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Comparative Study
Burden of illness of chronic low back pain in Sweden: a cross-sectional, retrospective study in primary care setting.
Cross-sectional survey of patients with chronic low back pain in primary care setting. ⋯ In Sweden, the indirect costs for chronic LBP appear to be substantially higher than the direct costs for pharmaceuticals, medical visits, physiotherapy, andhospitalizations. The high indirect costs indicate that more effective treatments for chronic LBP could potentially lead to cost savings even if the therapy costs were higher.
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A prospective, cohort study of 11 patients who underwent either a posterior lumbar spinal fusion with instrumentation (n = 7) or a lumbar laminotomy and discectomy alone (n = 4) and who were evaluated by dual energy radiograph absorptiometry (DEXA) to determine bone mineral density (BMD) at the adjacent three cephalad vertebral levels. ⋯ The local BMD adjacent to an instrumented lumbar fusion is increased at a mean of 10.8-years after surgery. There is a gradual decrease in BMD changes with increasing distance from the fusion level. Alterations in fusion site biomechanics and modulus mismatch between the host bone and the spinal instrumentation most likely result in chronic, localized bone remodeling with an increased BMD that decreases the greater the distance from the fusion mass.
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Comparative Study
Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation?
A review of 66 consecutive patients at a single institution who underwent one-level anterior cervical discectomy and fusion (ACDF) with rigid anterior plate fixation with allograft or autograft. ⋯ A 100% and 90.3% radiographic fusion rate was obtained for allograft and autograft in one-level ACDF procedures with rigid anterior plate fixation, respectively. Although autograft achieved a higher incidence of nonunion than allograft, this may be attributed to the use of autograft early in the experience of plate application and fixation in this series. The effects of smoking were not found to be a significant factor influencing fusion in these plated patients. In 90.9% of the patients, excellent and good clinical outcome results were reported. The use of allograft in one-level ACDF with rigid plate fixation yields similar and high fusion rates as autograft. The use of allograft bone eliminates complications and pitfalls associated with autologous donor site harvesting. However, the use of autograft is a viable alternative to avoid the risk of infection, disease transmission, and histocompatibility differences associated with allograft. The use of allograft or autograft bone in properly selected patients for one-level ACDF with rigid anterior plate fixation can result in high fusion rates with excellent and good clinical outcomes.