Spine
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Comparative Study
The Steffee variable screw placement system using different methods of bone grafting.
Two groups of patients with diseased lumbar spines treated by the Steffee variable screw placement system were studied, in order to compare concomitant posterolateral fusion and posterior lumbar interbody fusion. The use of posterolateral fusion resulted in less invasiveness than posterior lumbar interbody fusion, with regard to operating time and blood loss. With the posterolateral fusion method, correction of olisthesis or kyphotic deformity, if attained at all, was difficult to maintain. ⋯ Breakage or loosening of screws occurred in 14% of the posterolateral fusion group. Deep wound infection and adhesive arachnoiditis, which were never seen in the posterolateral fusion group, developed in 3% of the posterior lumbar interbody fusion group. Posterior lumbar interbody fusion is considered to be a better method of bone grafting than posterolateral fusion, when used with the Steffee variable screw placement system.
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The purpose of this study was to examine the mechanical function of the C1-C2 capsular ligaments. Physiologic torques of up to 1.5 Nm were applied to human fresh cadaveric specimens (C0-C1-C2-C3) in three dimensions, and the three-dimensional motion of C1 relative to C2 was recorded. Two groups of cadaveric specimens were used to study the effect of two different sequential ligamentous transections. ⋯ Lateral bending to the left also increased significantly by 1.5 degrees after both ligaments were cut. In the second group, with the nonfunctional alar and transverse ligaments, transection of the left capsular ligament resulted in greater increases in range of motion: 3.3 degrees to the right and 1.3 degrees to the left. Lateral bending to the right also increased significantly by 4.2 degrees.
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Spinal cord plasticity in 55 patients with cervical compression myelopathy was assessed with magnetic resonance imaging, by which the transverse area of the spinal cord was measured at the site of maximum compression before and after surgery and compared with the conventional modalities of computed tomographic myelography. A high correlation (r = 0.901, P less than 0.01) was observed between the preoperative measurements of magnetic resonance imaging and computed tomographic myelography. The preoperative transverse area was in good correlation with the preoperative Japanese Orthopaedic Association score (r = 0.466, P less than 0.01). In most patients with a spinal cord area of less than 0.45 cm2, the clinical results were poor despite considerable morphologic restoration of the spinal canal obtained after decompression surgery, reflecting an irreversible pathology developed in the spinal cord.
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Comparative Study
Disability exaggeration as a predictor of functional restoration outcomes for patients with chronic low-back pain.
Many of the individual biological, psychological, and social factors attributed to low-back disability have been tested previously for their ability to predict treatment outcomes. To test the assumption that disability exaggeration affects treatment outcomes, models were developed to quantify this complex characteristic and to test its predictive value. Two hundred fifty-eight patients with chronic back disability entering a program of functional restoration were initially evaluated with a battery of tests, including measurements of trunk flexibility, lifting capacity, cycling endurance, self-assessments of pain and disability, and psychological attributes. ⋯ There were no significant associations between any individual factor and 2-year work status. Only two of the 12 disability exaggeration models distinguished between program graduates and dropouts, and none of the models accurately predicted return to work following treatment. Prescription of intensive multidisciplinary treatment should not be denied on the basis of any individual patient attribute or of disability exaggeration, as measured in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Comparison of eight psychometric instruments in unselected patients with back pain.
A comparative evaluation of eight psychometric instruments was made in 274 patients who were currently suffering or previously had suffered from low-back pain. The specificity and sensitivity values for detection of psychological disturbance were calculated and optimum cutoff scores determined for each test. The influence of current pain, social group, compensation, migrant status, and unemployment on the accuracy of each test were evaluated. ⋯ The Modified Somatic Perception Questionnaire, the Hospital Anxiety Scale, the Hospital Depression Scale, and the Zung Depression Scale were the most accurate and least affected by the factors examined. The combination of the Modified Somatic Perception Questionnaire and the Zung Depression Scale yielded specificities and sensitivities of 91% and 84% for men and 96% and 85% for women, respectively. This combination is recommended for the assessment of psychological disturbance in patients with low-back pain.