The spine journal : official journal of the North American Spine Society
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Comparative Study
Can a patient educational book change behavior and reduce pain in chronic low back pain patients?
This study was prompted by 1) the almost universal use of patient education as an initial or at least an ancillary step in the treatment of patients presenting with low back pain, 2) the relative dearth of studies evaluating the effectiveness of patient education and 3) the complete lack of support in the few existing studies for the efficacy of education in improving patients' long-term health status. ⋯ This study's results suggest that the Treat Your Own Back book may have considerable efficacy in helping readers decrease their own low back pain and reduce the frequency of, or even eliminate, their recurrent episodes. These findings also justify conducting a randomized controlled clinical trial to assess this book's efficacy in improving health status in subjects with low back pain with the study design including internal controls to minimize bias issues and a wider range of outcomes, including measures of pain, function, disability, patient satisfaction, utilization of health care services and psychosocial measures.
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Comparative Study
Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis.
Vertebral osteomyelitis can be successfully treated with spinal immobilization and parenteral antibiotics. Failure of medical therapy may necessitate surgical treatment consisting of anterior debridement and structural anterior column reconstruction. Autologous structural bone graft has traditionally been the gold standard in anterior column reconstruction. Because of the morbidity related to graft harvest, vertebral body replacement cages have emerged as a viable option for reconstructing a deficient anterior column. ⋯ Cylindrical titanium mesh can be used with consistently good results for large anterior column defect reconstructions even in the face of active pyogenic infection. In our cohort of patients with pyogenic vertebral osteomyelitis, the use of titanium mesh cages has not been associated with early recurrence of infection.
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Comparative Study
Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern?
Surgeons are hesitant to mix components made of differing metal classes for fear of galvanic corrosion complications. However, in vitro studies have failed to show a significant potential for galvanic corrosion between titanium and stainless steel, the two primary metallic alloys used for spinal implants. Galvanic corrosion resulting from metal mixing has not been described in the literature for spinal implant systems. ⋯ The results from this study indicate that when loaded dynamically in saline, stainless steel implant components have a greater susceptibility to corrosion than titanium. Furthermore, the galvanic potential between the dissimilar metals does not cause a discernible effect on the corrosion of either. Although the mixture of titanium alloy with stainless steel is not advocated, the results of this study suggest that galvanic corrosion is less pronounced in SS-Ti mixed interfaces than in all stainless steel constructs.
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Comparative Study
Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial.
The prognostic value of injury severity and of anatomical region in acute spinal cord injury is strong, making it hard to evaluate other indicators or assess improvement without considering them. ⋯ AIS severity was the strongest predictor. Anatomical region was also strong but confounded with the severity effect, because the cervicals had fewer complete injuries, and because the cervical complete group did better than thoracic complete. The injury region/severity variable keeps the strong prognostic value of using both region and severity, but is simpler and more statistically economical.