The spine journal : official journal of the North American Spine Society
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Epidural steroid injection (ESI) is one of the most common nonsurgical interventions prescribed for back and leg pain symptoms. Although the use of ESI is widespread, proof of efficacy among the broad population of low back pain patients is lacking and use is predicated to a great extent on the cost and morbidity of the perceived "next step" in many patient's care-surgery. ⋯ Randomized, controlled trials are needed to conclusively identify those patients most likely to benefit from ESI, and when and for how long. Until then, epidural steroids provide a reasonable alternative to surgical intervention in selected patients with back and/or leg pain, whose symptoms are functionally limiting. When appropriate goals are established and proper patients are selected, sufficient short-term benefit has been documented to warrant continued use of this tool.
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The role of surgical correction of sagittal plane deformity in cases of lytic spondylolisthesis remains controversial. While some early evidence is emerging of the possible short- and long-term benefits of restoring spinal balance, many surgeons have been concerned about the associated risks. The insert-and-rotate posterior lumbar interbody fusion (PLIF) technique, first described by Jaslow in 1946, may enable surgeons to safely and effectively correct sagittal balance through a single posterior approach. ⋯ This series suggests that PLIF using an insert-and-rotate technique can yield satisfactory clinical outcomes and substantial deformity correction using a posterior only approach and with low levels of serious or permanent complications. Longer-term clinical outcome and comparative studies are required regarding the importance of the restoration of spinal balance.
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Prolonged sitting may alter the passive stiffness of the lumbar spine. Consequently, performing full lumbar flexion movements after extended periods of sitting may increase the risk of low back injury. ⋯ Changes in the passive flexion stiffness of the lumbar spine may increase the risk of low back injury after prolonged sitting and may contribute to low back pain in sitting.
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Although satisfactory clinical outcomes have been reported for degenerative spondylolisthesis using a variety of surgical techniques, its optimal management remains controversial. Laboratory and clinical evidence is emerging that if fusion surgery is undertaken, improved short- and longer-term outcomes may be achieved by correcting any sagittal deformity present. The insert-and-rotate posterior lumbar interbody fusion (PLIF) technique, first described by Jaslow in 1946, may enable surgeons to safely and effectively correct sagittal balance through a single posterior approach. ⋯ This series suggests that PLIF for degenerative spondylolisthesis using an insert-and-rotate technique can yield high levels of patient satisfaction with low levels of complications and substantial deformity correction using a posterior only approach. Longer-term outcome studies are required regarding the relevance of the restoration of spinal balance.
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Dysphagia is a frequent complication after anterior cervical interbody fusion (ACIF). Although dysphagia usually improves over 6 months, it remains a significant and persistent problem for some patients. The etiology is poorly understood but has been reported to be associated with vocal cord paralysis, dislodgement of instrumentation and unidentified causes, such as hematoma, adhesion formation and denervation of the pharyngeal plexus. A surgical treatment of dysphagia after ACIF has not been reported. ⋯ Surgical treatment of dysphagia after ACIF has not been reported. Removal of the cervical instrumentation in patients will improve the dysphagia. This improvement with surgical management, as compared with the dissatisfaction before surgical treatment, documents that this surgical treatment is a reasonable option.