Spine
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Do corticosteroids produce additional benefit in nerve root infiltration for lumbar disc herniation?
Experimental animal study. ⋯ NRI prevented mechanical allodynia. However, no additional benefit from using corticosteroid was identified, suggesting that corticosteroid may be unnecessary for NRI.
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This study was aimed at investigating changes in the dorsal horn of the lumbar cord induced by mechanical compression using an in vivo model. ⋯ It is important to recognize that compressive disturbance of the nerve roots caused Wallerian degeneration not only at the site of compression of nerve roots but also at the synapses of spinal cord dorsal horns.
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Multicenter Study
Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations.
Retrospective survey. ⋯ The incidence of VAI during cervical spine surgery from this survey was similar to or slightly less than that in the literature. Tamponade was effective in many cases, but prompt consultation with an endovascular team is recommended if the bleeding is uncontrollable. Preoperative careful evaluation of the vertebral artery seems to be most important to prevent iatrogenic VAI and to avoid postoperative neurologic sequelae.
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Prospective validity study. ⋯ Based on these findings, we recommend use of live fluoroscopy to observe dynamic contrast flow during transforaminal epidural steroid injections.
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An immature bovine model was used to evaluate multilevel anterolateral flexible tethering in a growing spine. ⋯ Tethering resulted in vertebral wedging while maintaining spinal flexibility. Although changes in proteoglycan synthesis, collagen type distribution, and disc thickness were observed, the tethered discs had similar water content to control discs and did not demonstrate gross morphologic signs of degeneration. Growth modulation is an attractive treatment option for growing patients with scoliosis, avoiding multilevel fusions or brace wear. Strategies for fusionless scoliosis correction should preserve disc health, as adolescent patients will rely on these discs for decades after treatment.