Spine
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Randomized Controlled Trial Multicenter Study
Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial.
Randomized, parallel-group trial. ⋯ Immobilization, "act-as-usual," and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury.
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Reanalysis of data derived from longitudinal cohort studies. ⋯ We recommend the 5-item CWOM as a brief clinical measure for whiplash because it is quick to administer and score, and has excellent measurement properties. The CWOM may need to be supplemented with other questionnaires (e.g., when assessment of psychological or emotional health is required).
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Randomized Controlled Trial
Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial.
A randomized, double-blind placebo controlled trial in multimodal analgesia for postoperative pain was conducted. ⋯ Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.
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Randomized Controlled Trial
Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices.
Prospective, randomized, controlled and double-blinded study on imaging of artificial discs. ⋯ Preoperative and postoperative magnetic resonance imaging scans of 20 patients who had undergone cervical arthroplasty were assessed for imaging quality. Five cases each of the Bryan (Medtronic Sofamor Danek, Memphis, TN), Prodisc-C (Synthes Spine, Paoli, PA), Prestige LP (Medtronic Sofamor Danek), and PCM devices (Cervitech, Rockaway, NJ) were analyzed. Six blinded spinal surgeons scored twice sagittal and axial T2-weighted images using the Jarvik 4-point scale. Statistical analysis was performed comparing quality before surgery and after disc implantation at the operated and adjacent levels and between implant types. RESULTS.: Moderate intraobserver and interobserver reliability was noted. Preoperative images of patients in all implant groups had high-quality images at operative and adjacent levels. The Bryan and Prestige LP devices allowed satisfactory visualization of the canal, exit foramina, cord, and adjacent levels after arthroplasty. Visualization was significantly impaired in all PCM and Prodisc-C cases at the operated level in both the spinal canal and neural foramina. At the adjacent levels, image quality was statistically poorer in the PCM and Prodisc-C than those of Prestige LP or Bryan. CONCLUSIONS.: Postoperative visualization of neural structures and adjacent levels after cervical arthroplasty is variable among current available devices. Devices containing nontitanium metals (cobalt-chrome-molybdenum alloys in the PCM and Prodisc-C) prevent accurate postoperative assessment with magnetic resonance imaging at the surgical and adjacent levels. Titanium devices, with or without polyethylene (Bryan disc or Prestige LP), allow for satisfactory monitoring of the adjacent and operated levels. This information is crucial for any surgeon who wishes to assess adequacy of neural decompression and where monitoring of adjacent levels is desired.
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Randomized Controlled Trial Multicenter Study Comparative Study
Evaluation of spinal kinematics following lumbar total disc replacement and circumferential fusion using in vivo fluoroscopy.
In vivo fluoroscopic analysis of lumbar spinal motion with total disc replacement (TDR), fusions, and controls. ⋯ TDR produces physiologic lumbar spinal motion profiles in flexion and extension at the operative and proximal adjacent levels. Fusions, however, produced steeper motion gradients at the proximal adjacent level, while undergoing significantly greater sagittal plane translation during flexion-extension.