Spine
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Prospective clinical study of total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA). ⋯ Baseline ODI and early postoperative outcome parameters (< or =6 months) revealed significant and strong associations with the final results following TDR. While the vast majority of patients with an early highly satisfactory outcome maintained satisfactory results at later FU stages, any significant improvement considered as "highly satisfied" is unlikely in a group of patients which reported early unsatisfactory results. In summary, any clinically relevant changes are unlikely to occur after the early postoperative period.The current findings offer a foundation for weighing both the patients and the spine surgeons expectations against possible realistic achievements. Although the data show that the midterm outcome at a FU of 4 years (mean: 45.5 months, range: 24.1-94.4 months) is predictable following TDR, the long-term results of lumbar disc replacements still need to be established.
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Retrospective clinical review and prospective report of postoperative delirium after cervical spine surgeries. ⋯ Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly.
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Experimental study of corticospinal axonal sprouting in an organotypic slice culture model. ⋯ Our data suggest that the absence of repellent factors such as white matter and the presence of neurotrophic factors promote axonal sprouting. Cocultures of sensorimotor cortex and spinal cord slices combined with anterograde axonal labeling could provide a valuable in vitro model for the simplified screening of factors influencing corticospinal tract regeneration.
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Randomized Controlled Trial Multicenter Study Comparative Study
Segmental contribution toward total lumbar range of motion in disc replacement and fusions: a comparison of operative and adjacent levels.
Radiographic results from a prospective, randomized, multicenter trial assessing patients who underwent lumbar total disc replacement (TDR) or circumferential arthrodesis for 1-level degenerative disc disease. ⋯ In conclusion, patients with TDR lost slight relative contribution to total lumbar motion from the operative level which was mostly compensated for by the caudal adjacent level (if operated at L4/5). In contrast, the significant loss of relative range of motion contribution from the operative level in fusions was redistributed among multiple cranial adjacent levels, most notably at the first cranial adjacent level.
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Systematic review of clinical guidelines. ⋯ Compared to the quality assessment performed in 2004, the average quality of guidelines has improved. However, guideline developers should still improve the quality transparency of the development process. Especially the applicability of guidelines and the editorial independence need to be ensured in future guidelines.