European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The total costs for patients who are sick-listed due to back and neck problems have not previously been determined prospectively on an individual basis. This study aimed to determine the total cost to a society, based on individually assessed costs of health services and loss of production in people who are sick-listed 28 days or more for back or neck problems. Detailed data on individuals' health-care consumption due to back or neck problems was collected through prospectively entered diaries and questionnaires, after 4 weeks, 3 months, 1 and 2 years, in a consecutively selected cohort of 1,822 employed persons aged between 18 and 59 years. ⋯ The single most expensive medical service was surgery. Transferred to a national level, annual total costs for back and neck problems corresponded to 1% of GNP. In conclusion, direct health-service costs were a small fraction of the total costs, consequently indirect costs offer the greatest potential for savings.
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Whiplash has been simulated using volunteers, whole cadavers, mathematical models, anthropometric test dummies, and whole cervical spines. Many previous in vitro whiplash models lack dynamic biofidelity. The goals of this study were to (1) develop a new dynamic whole cervical spine whiplash model that will incorporate anterior, lateral and posterior muscle force replication, (2) evaluate its performance experimentally and (3) compare the results with in vivo data. ⋯ The peak in vivo intervertebral rotations obtained during a 4.6 g whiplash simulation of a young volunteer were within, or only marginally in excess of, the 95% confidence limits of the average peak intervertebral rotations measured during the 4.7 g whiplash simulation of the present study. Thus, the new whole cervical spine model with muscle force replication produced biofidelic dynamic responses to simulated whiplash. The new model is capable of generating important biomechanical data that may help improve our understanding of whiplash injuries and injury mechanisms.
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In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. ⋯ Pain intensity was evaluated by visual analog scale (VAS), and the patients' function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.
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The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. ⋯ We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.
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Cervical spine fractures in patients with ankylosing spondylitis are serious and potentially lethal injuries with high complication rates. Treatment obstacles include long lever arms that generate large forces on any fixation device, osteoporosis, and, usually, kyphotic deformity. The Olerud Cervical Fixation System (OC), with cervical pedicle screws and rods, offers an opportunity to create a biomechanically stable posterior fixation in these complicated cases. ⋯ Extensive peroperative bleeding was encountered in two patients. One deep-wound infection was noted, postoperatively, and required surgical drainage, but no patients have been re-operated due to loosening of the instrument or to healing problems. In conclusion, the results of the present study indicate that the OC--and possibly other similar long-fixation systems that allow using both pedicle screws and lateral mass screws rigidly connected to a rod--is suited for treating subaxial cervical spine fractures in patients with ankylosing spondylitis, allowing high healing rates.