Spine
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This study investigated the clinical usefulness of motor-evoked potentials (MEPs) produced by transcranial magnetic stimulation of the brain for cervical myelopathy patients. ⋯ In patients with cervical myelopathy, the CMCT significantly correlated with the results of clinical assessment. These findings regarding the duration of CMCT may be useful parameters in spinal pathology for prediction of the outcome of surgical treatment.
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Review
Psychosocial interventions for low back pain in primary care: lessons learned from recent trials.
Workshop discussion and literature overview. ⋯ Despite the publication of recent "negative" results of psychosocial interventions for back pain, workshop participants remained optimistic about the importance of this line of research. Suggestions are given for a refocused research agenda on the effectiveness of psychosocial interventions for back pain in primary care.
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Review Comparative Study
Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care.
Descriptive study. ⋯ This study has identified differences between the guidelines in the clinical decision rules for identification of neurologic involvement including omission of categories. Decision-making that employs all 3 categories of neurologic involvement will arguably facilitate accurate and timely identification of patients with low back pain so affected in primary care.
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Clinical Trial
The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level.
Prospective longitudinal clinical study. ⋯ Microdiscectomy for symptomatic lumbar disc herniations in young, active patients with a preponderance of leg pain who have failed nonoperative treatment demonstrated a high success rate based on validated outcome measures, patient satisfaction, and return to active duty. Patients with disc herniations at the L5-S1 level had significantly better outcomes than did those at the L4-L5 level. Patients with sequestered or extruded lumbar disc herniations had significantly better outcomes than did those contained herniations. Patients with contained disc herniations, a predominance of back pain, on restricted duty and smoking should be counseled before surgery of the potential for less satisfaction, poorer outcomes scores, and decreased return to duty rates.
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A method comparison study. ⋯ Horizontal MRI with the patient supine and the legs straightened was comparable to vertical MRI whether axial compression was added or not. Extensionwas the dominant cause rather than compression in reducing DCSA. Axial load was not considered to have a clinically relevant effect on spinal canal diameters.