Journal of spinal disorders
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The purpose of this study was to compare the secondary axes activity of normal subjects and low back pain patients. Each subject performed maximum isometric trials in all six primary directions. ⋯ The results showed that for all movement axes the secondary axes torques were significantly less (p = 0.01-0.001) for low back pain patients compared to normal subjects. The secondary axes torques were generally weakly related to an individual's ability to both generate maximum isometric torques about the same axis and the primary axes maximum velocities.
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Randomized Controlled Trial Clinical Trial
A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain.
This randomized clinical trial evaluated the efficacy of injections of a dextrose-glycerine-phenol connective tissue proliferant into the posterior ligaments, fascia, and joint capsules to treat chronic low back pain. Seventy-nine patients with chronic low back pain that had failed to respond to previous conservative care were randomly assigned to receive a double-blind series of six injections at weekly intervals of either Xylocaine/saline solution or Xylocaine/proliferant into the posterior sacroiliac and interspinous ligaments, fascia, and joint capsules of the low back from L4 to the sacrum. Patients were observed with a visual analog, disability, and pain grid scores, and with objective computerized triaxial tests of lumbar function for 6 months following conclusion of injections. ⋯ Improvements in visual analog (p = 0.056), disability (p = 0.068), and pain grid scores (p = 0.025) were greater in the proliferant group. Objective testing of range of motion, isometric strength, and velocity of movement showed significant improvements in both groups following treatment but did not favor either group. The MRI and CT scans showed significant abnormalities in both groups, but these did not correlate with subjective complaints and were not predictive of response to treatment.
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We describe a patient who suffered an upper cervical spine fracture despite wearing a seat belt and deployment of an air bag system. All individuals treating trauma victims should be aware that a potentially life-threatening injury can occur despite proper use of optimal available restraints.
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This study was designed to observe the length dependence of a well-molded fiberglass body cast attached to a halo on motion restriction in an unstable cadaveric cervical spine. Also, by using this technique, comparison between the immobilization provided by a body cast and that provided by a standard premolded polyethylene halo vest could be made. Extreme cervical instability was created on adult cadavers. ⋯ Results revealed minimal motion difference as the fiberglass body cast was sequentially shortened. In contrast, motions within the polyethylene halo vest were variable. These results suggest that cervical immobilization may be relatively independent of support structure length and that immobilization can be maintained by a well-fitting halo vest extending to the level of the xiphoid process.
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Historically, early management of the blunt trauma victim with hemodynamic instability and cervical spinal cord injury has been hampered by the physician's inability to perform an accurate physical examination. Invasive and time-consuming diagnostic tests are often run to check for the presence of occult intra-abdominal injuries. For this reason, we decided to study these patients by reviewing a clinical registry to assess the frequency of intra-abdominal injuries in cases of cervical spinal cord trauma. ⋯ In fact, data from the Maryland Institute for Emergency Medical Services Systems revealed that blunt trauma victims with cervical cord injury rarely (2.6%) sustained intra-abdominal wounds. Further analysis of this population revealed that specific mechanisms of trauma and the presence of hemodynamic instability and other major injuries were factors strongly associated with occult intra-abdominal injury. In light of these findings, we have outlined a protocol for management of these patients that is geared toward more rapid stabilization of the injured spinal column.