Spine
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Randomized Controlled Trial
Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.
Cost-effectiveness analysis alongside a cluster randomized controlled trial. ⋯ Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.
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Comparative Study
Primary pyogenic infection of the spine in intravenous drug users: a prospective observational study.
A prospective comparative analysis of surgically-treated nontuberculous primary pyogenic infection of the spine (PPIS). ⋯ There are significant differences in demographics, presentation, treatment and outcomes of primary spinal pyogenic infection between a population of IVDU and a comparable cohort of non-IVDU. The IVDU group presents with cervical quadriplegia while it is the thoracolumbar spine that is almost exclusively involved in the non-IVDU group. Among the IVDUs, surgical management is complex with a high incidence of early hardware failure. SSI is significantly more common among non-IVDU. Significant neurological improvement can be expected in the majority of IVDU patients with a high mortality rate among the non-IVDU. IVDU are unreliable patients and in-hospital, in-halo incarceration is recommended where possible.
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Retrospective study of computed tomography-guided navigation (CTGN) of thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis (AIS). ⋯ CTGN resulted in more optimally placed thoracic pedicle screws, fewer potentially unsafe screws, and fewer screw removals.
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Prospective cohort study. ⋯ The total score of the PDI as well as the subscale of voluntary activities is responsive. Partly because of floor effects, the subscale obligatory activities are not sufficiently responsive in patients with CBP. However, the responsiveness of this subscale in other patient groups should be further tested. In patients with CBP, change can be considered clinically important when PDI score has decreased 8.5 to 9.5 points.
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Case report with 40-year follow-up after definitive surgery. ⋯ Extensive thoracic spine fusion at an early age did not result in early death, but the patient is far from ideal.