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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Clinical Trial
Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome?
Chronic musculoskeletal pain is often associated with psychological distress and maladaptive beliefs and these are sometimes reported to have a negative impact on surgical outcome. The influence of a surgical intervention, and in particular its outcome, on the course of change in psychological status is poorly documented. In this prospective study, we sought to examine the dynamic interplay between psychological factors and outcome in patients undergoing decompression surgery for spinal stenosis/herniated disc. ⋯ In a multivariable prospective (predictive) model, FABQ-PA was the only baseline psychological factor that significantly predicted outcome. Future studies should assess whether pre-operative cognitive-behavioural therapy in patients with maladaptive beliefs improves treatment outcome. Psychological disturbance did not significantly predict outcome, but it improved post-operatively in patients with a good outcome and worsened in those with a poor outcome. Rather than being a risk factor for poor outcome, in this group it appeared to be more a consequence of long-standing, unremitting pain that improved when symptoms resolved after successful surgery.
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Development of a dynamic stabilization system often involves costly and time-consuming design iterations, testing and computational modeling. The aims of this study were (1) develop a simple parametric model of lumbar flexion instability and use this model to identify the appropriate stiffness of a flexion restricting stabilization system (FRSS), and (2) in a cadaveric experiment, validate the predictive value of the parametric model. ⋯ Testing demonstrated excellent predictive value of the parametric model, and that the FRSS attained the desired biomechanical performance developed with the model. A simple parametric model may allow efficient optimization of kinematic design parameters.
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A retrospective review of prospectively collected data in an academic institution. ⋯ The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.
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Cervical spine pyogenic infections are unusual compared to other vertebral segments, but they can be associated to worse clinical outcomes. We compared all patients with cervical spine pyogenic infections to those with thoracolumbar involvement in terms of epidemiology, prognostic factors and clinical outcomes. ⋯ An early diagnosis and prompt treatment should be the goal treating cervical PSI, considering the potential devastating complications and increased mortality.