The journal of spinal cord medicine
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Little is known about the long-term effects of chronic exposure to ionizing radiation. Studies have shown that spine surgeons may be exposed to significantly more radiation than that observed in surgery on the appendicular skeleton. Computer-assisted image guidance systems have been shown in preliminary studies to enable accurate instrumentation of the spine. Computer-assisted image guidance systems may have significant application to the surgical management of spinal trauma and deformity. The objective of this study was to compare C-arm fluoroscopy and computer-assisted image guidance in terms of radiation exposure to the operative surgeon when placing pedicle screw-rod constructs in cadaver specimens. ⋯ Computer-assisted image guidance systems allow for the safe and accurate placement of pedicle screw-rod constructs with a significant reduction in exposure to ionizing radiation to the torso of the operating surgeon.
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Intrathecal baclofen (ITB) has been shown to be an effective treatment for severe spasticity of spinal or cerebral origin. Although most patients respond well to an ITB trial, there are often difficulties in achieving and/or maintaining such effectiveness with ITB pump treatment. There are few published guidelines for dosing efficacy and no studies looking at the effect of concentration of ITB on spasticity management. ⋯ Decreasing the concentration of ITB seems to affect spasticity control. Further research in this area is needed for those patients with refractory spasticity to optimize efficacy of ITB therapy.
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To evaluate the accuracy and agreement of International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) classification and to determine the effectiveness of formal training for pediatric clinicians. ⋯ This study demonstrated the benefits of formal, standardized training for accurate classification of the ISCSCI. Effective training programs must emphasize the guidelines and decision algorithms used to determine motor level and ASIA AIS designations because these remained problematic after training and are often a concern of patients/parents and are primary endpoints in clinical trials for neurological recovery.