Journal of spinal disorders
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Randomized Controlled Trial Comparative Study Clinical Trial
Overexertional lumbar and thoracic back pain among recruits: a prospective study of risk factors and treatment regimens.
A total of 395 male infantry recruits were evaluated in a prospective study of possible risk factors for overexertional back pain and the efficacy of drug treatment regimens for this syndrome. Recruits were classified into subgroups of lumbar or thoracic, and paraspinal or spinous process pain. Recruits were divided into three treatment groups: Ibuprofen, Paracetamol, and no drug treatment. ⋯ By multivariate analysis low body mass index was found to be a risk factor for overexertional lumbar pain (p = 0.005) and increased lumbar lordosis a risk factor for overexertional thoracic pain (p = 0.005). Of recruits with overexertional back pain, 65% were asymptomatic by the end of basic training. There was no statistically significant difference between cure rates according to treatment groups.
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The aetiology of postoperative back pain is contentious. Although the role of the surgical position has not been fully established, the lithotomy position is often implicated. In order to investigate this common surgical complication further, a prospective study has been performed on 101 hysterectomy patients. ⋯ Ten patients in the supine group (20%) and seven patients in the lithotomy group (14%) developed postoperative low back pain (p > 0.1). The mean duration of symptoms postoperatively for the whole series was 7 months. We conclude that postoperative backache is an under-estimated complication of surgery and that this problem occurs equally whether the supine or the lithotomy positions are used.
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The ability to monitor the descending motor pathways of the spinal cord during surgery is an important goal in neurophysiologic monitoring of spinal deformities. This report describes a case of a severe spinal deformity for which instrumentation and reduction carried a significant risk of neurologic complications. ⋯ The reliability of these two complimentary modalities was then verified by concurrent wake-up tests. This case provides documentation of the reliability of tcMMEP responses when an accurate assessment of motor function was necessary.
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Case Reports
Salvage reconstruction in acute and late sequelae from pyogenic thoracolumbar infection.
Nine patients treated surgically for complicated pyogenic osteomyelitis of the thoracolumbar spine are reported. All patients were treated with anterior debridement and stabilization with nonvascularized autogenous fibular strut grafts. In addition, seven underwent a posterior spinal fusion with instrumentation. ⋯ Seven patients had postoperative improvement or resolution of their back pain. The use of nonvascularized autogenous fibular strut grafts for reconstruction of the spine following debridement for vertebral osteomyelitis is an effective procedure. The advantages of using the fibula for grafting are its strength and length for spanning several vertebral segments, and it can provide multiple grafts.