Spine
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Randomized Controlled Trial Pragmatic Clinical Trial
Costs and cost-effectiveness of epidural steroids for acute lumbosacral radicular syndrome in general practice: an economic evaluation alongside a pragmatic randomized control trial.
A pragmatic, randomized, controlled, single-blinded trial in Dutch general practice. ⋯ The effect on pain and disability of epidural steroids in lumbosacral radicular syndrome is small but significant, and at lower costs with no reported complications or adverse effects. Segmental epidural steroid injections could be considered by policy makers as an additional treatment option.
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A retrospective radiographical study. ⋯ This study demonstrated that the lower EV disc degeneration strongly correlated with sagittal imbalance in patients with DLS, implying that disc degeneration may be regarded as a potential risk factor for sagittal imbalance. This result strengthened the importance of not selecting the lower EV as the lower instrumented vertebra during the surgical decision making, which may lead to deterioration of sagittal balance. Disc degeneration was also strongly correlated with sagittal malalignment, as demonstrated by a more positive SVA, decreased TK and LL, providing insight into reasons for low quality of life in elderly patients with DLS.
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Prospective cohort study. ⋯ Patients undergoing elective lumbar arthrodesis reported relatively limited functional deficit due to stiffness at 2-year follow-up. Paradoxically, patients undergoing 1-level arthrodesis actually reported significantly less limitation due to stiffness postoperatively. Although the effects of stiffness did trend toward greater impacts among patients undergoing longer fusions, 91% of patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.
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Retrospective cohort analysis of prospectively collected data. ⋯ Obesity did not affect the amount of deformity correction and did not increase comorbidities and postoperative complication rates. Overweight patients had a greater lumbar lordosis before surgery than normal weight patients. Obese and overweight patients benefited from surgery just as much as normal weight patients at 2-year follow-up.
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A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. ⋯ DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.