Spine
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Clinical Trial
A gold standard evaluation of the "discogenic pain" diagnosis as determined by provocative discography.
This is a prospective study of the validity of a positive test result in provocative lumbar discography for the diagnosis of "discogenic pain." ⋯ Positive discography was not highly predictive in identifying bona fide isolated intradiscal lesions primarily causing chronic serious LBP illness in this first study comparing discography results to a gold standard.
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Fifteen asymptomatic volunteers were externally rotated and CT scanned to determine lumbar segmental motion. ⋯ Complex coupled motions were measured due to external torsion and could be indicative of instability chronic patients with low back pain. The presented data provide baseline segmental motions for future comparisons to symptomatic subjects.
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Comparative Study
Biomechanical and clinical evaluation of a novel technique for surgical repair of spondylolysis in adolescents.
A biomechanical comparison of a novel spondylolysis repair technique method to established spondylolysis repair constructs accompanied by a case series of 5 adolescent patients with spondylolysis treated with this technique. ⋯ Biomechanical evaluation of the intralaminar link construct showed excellent stability of a spondylolytic defect in comparison to established methods. Clinical follow-up of this method reflects the results of biomechanical testing with excellent clinical results.
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Prospective analysis of a consecutive series in which multimodality intraoperative neurophysiologic monitoring was used as an adjunct to microneurosurgery for adult tethered cord syndrome. The results of multimodality intraoperative neurophysiologic monitoring were compared with the "gold standard" (neurologic outcomes). ⋯ To our knowledge, this is the largest series to date reporting the use of multimodality intraoperative neurophysiologic monitoring in the surgical management of adult tethered cord syndrome. Posterior tibial nerve SSEPs have high specificity, but low sensitivity, for predicting new neurologic deficits. In contrast, continuous EMG showed high sensitivity and low specificity. Evoked EMG accurately identified functional neural tissue. The combined recording of SSEPs in concert with continuous and evoked EMGs may provide a useful adjunct to complex microsurgery for adult tethered cord syndrome.
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Multicenter, prospective, consecutive clinical series. ⋯ A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.