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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Randomized Controlled Trial Clinical Trial
Day-case conventional discectomy: a randomised controlled trial.
A prospective randomised trial compared the results of conventional lumbar discectomy performed as day cases with those performed on an in-patient basis. The aim of the study was to investigate whether conventional discectomy can be performed safely on a day-case basis. ⋯ The rate of complications was unchanged. It is concluded that conventional discectomy can be undertaken safely as day-case surgery and may indeed speed up the recovery process.
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Comparative Study Clinical Trial Controlled Clinical Trial
Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study.
This study investigated electromyographic (EMG) activity as a marker of nerve root irritation during two different surgical procedures for lumbar disc herniation. Mechanically elicited EMG activity was recorded during the dynamic stages of surgery in muscle groups innervated by lumbar nerve roots. Confirmation of surgical activity was correlated with the activity of the electromyogram. ⋯ Results indicated that the endoscopic technique was superior to the open surgical technique and produced less irritation of the nerve root. Significantly less mechanically elicited activity was recorded during both the approach and the root mobilization. The study showed that microendoscopic discectomy allows a smaller incision and less tissue trauma with comparable visualization of the nerve structures than does open surgery.
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Clinical Trial
Thoracolumbar spinal fractures: segmental range of motion after dorsal spondylodesis in 82 patients: a prospective study.
In order to study the effect of dorsal spondylodesis on intervertebral movement in patients treated for thoracolumbar fractures, we measured the sagittal range of motion (ROM) in the segments above and below the fractured vertebral body 2 years after operation. Between 1991 and 1996, 82 consecutive patients with a fracture of the thoracolumbar spine (T12, L1, L2 and L3) were treated operatively with open reduction and stabilisation using an internal fixator, combined with transpedicular cancellous bone graft and dorsal spondylodesis. Eighteen T12, 42 L1, 17 L2 and 5 L3 fractures were included. ⋯ All other evaluated segments showed significant loss of ROM (P<0.05) compared to normal values, except segment L1-L2 in L3 fractures (P=0.058). Dorsal spondylodesis at the level of the disturbed endplate in thoracolumbar spinal fractures leads to immobility in this segment, measured on flexion-extension radiographs 2 years after primary operative treatment. More than 50% loss of motion in the two adjacent levels is equivalent to complete loss of ROM in a second segment.
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Nucleus pulposus and/or chronic compression can induce spinal nerve root injury. Inflammation has been proposed as having major importance in the pathophysiologic mechanisms involved in the induction of such injuries. Corticosteroids, potent anti-inflammatory drugs, have been demonstrated to reduce nucleus pulposus-induced spinal nerve root injury. The aim of the present study was to assess the effects of two potent non-steroidal anti-inflammatory drugs (NSAIDs), diclofenac and ketoprofen, in experimental nucleus pulposus-induced spinal nerve root injury in a pig model. ⋯ This study of two potent NSAIDs indicates that nucleus pulposus-induced nerve root dysfunction may be reduced by diclofenac but not by ketoprofen. The reason for this difference is not known, but it might be related to the fact that ketoprofen and diclofenac belong to different NSAID subgroups and have a different selectivity for the two cyclo-oxygenases COX-1 and COX-2.
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Intradiscal pressure after repeat intradiscal injection of hypertonic saline: an experimental study.
Chemonucleolysis with chymopapain is an effective alternative to an operation for the treatment of some patients who have a lumbar intervertebral disc herniation. However, chymopapain is associated with rare but serious complications. Accordingly, alternative substances for chemonucleolysis have been sought. ⋯ The intradiscal pressure of the group with repeat hypertonic saline injection at 4 weeks was significantly lower than that of the control group. The decreased pressure showed a tendency to increase at 8 weeks, and it had recovered at 12 weeks. The results of this study suggest that repeat hypertonic saline injections may be clinically useful.