Spine
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Comment Review
Counterpoint: physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed.
Review of the nature of conflicts of interest in physician-industry relationships, with a focus on the efforts to ethically manage physician-industry relationships. ⋯ Careful consideration of conflicts of interest in physician-industry relationships has provided an opportunity to review our goals as physicians in society, and to continue collaborative advancement of our field for the benefit of our patients.
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Comparative Study
SF-36 PCS benefit-cost ratio of lumbar fusion comparison to other surgical interventions: a thought experiment.
A retrospective review of prospectively collected data. ⋯ While the exact numbers may vary for each treatment based on the population studied and the cost estimates used, lumbar fusion cost per benefit achieved was very comparable to other well-accepted medical interventions (total hip replacement, total knee replacement, and coronary artery bypass surgery).
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Multicenter Study
Cervical transforaminal epidural steroid injections: more dangerous than we think?
Survey/case series. ⋯ This study demonstrates a significant risk of serious neurologic injury after cervical TF-ESIs. A growing body of evidence supports an embolic mechanism, whereby inadvertent intra-arterial injection of particulate corticosteroid causes a distal infarct. Embolism to the distal basilar artery region can cause midbrain, pons, cerebellum, thalamus, temporal and occipital lobe infarctions. Other potential mechanisms of infarction include vertebral artery perforation causing dissection/thrombosis and needle-induced vasospasm.
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Comparative Study
Biomechanical comparison of instrumented and uninstrumented multilevel cervical discectomy versus corpectomy.
In vitro flexibility test comparing biomechanics of cervical corpectomy versus discectomy with and without instrumentation. ⋯ Less difference in stability was observed than was predicted between specimens receiving multilevel discectomy versus multilevel corpectomy, regardless of whether specimens were left unplated, plated anteriorly, or fixated with combined anterior/posterior instrumentation.
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Comparative Study
rhBMP-2 (ACS and CRM formulations) overcomes pseudarthrosis in a New Zealand white rabbit posterolateral fusion model.
The study design consisted of a New Zealand white rabbit model of pseudarthrosis repair. Study groups consisting of no graft, autograft, or recombinant human bone morphogenetic protein-2 (rhBMP-2) with absorbable collagen sponge (ACS) or compression resistant matrix (CRM) were evaluated. ⋯ The 2 rhBMP-2 formulations led to significantly higher fusion rates and histologic bone formation than no graft and autograft controls in this pseudarthrosis repair model.