The spine journal : official journal of the North American Spine Society
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Comparative Study
Psychometric properties of the Cervical Spine Outcomes Questionnaire and its relationship to standard assessment tools used in spine research.
The Cervical Spine Outcomes Questionnaire (CSOQ), a disease-specific outcomes instrument, has not been systematically compared with the Short Form-36 (SF-36) or the Neck Disability Index (NDI). ⋯ The CSOQ domain scores provide a disease-specific assessment of functional limitations resulting from cervical spine disorders. The domain scores for functional disability and psychological distress provide similar information to that provided by the NDI and SF-36. The CSOQ domain scores for pain severity provide information that is more specific to cervical disc disease than does the physical health score of the SF-36.
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Comparative Study
Augmentation of occipitocervical contoured rod fixation with C1-C2 transarticular screws.
The technique of occipitocervical fusion using a threaded contoured rod attached with sublaminar wires to the occiput and upper cervical vertebrae is widely used throughout the world and has been clinically proven to provide effective fixation of the destabilized spine. However, this system has some disadvantages in maintaining stability, especially at C1-C2 because of the large amount of axial rotation at this level. In some clinical situations such as fracture of the C1 lamina, C1 laminectomy, and excessively lordotic curvature, it is not always possible to wire C1 directly into the construct. In such cases, combination of other stabilization methods that include C1 indirectly can be used to achieve a reliable posterior internal fixation. ⋯ Adding C1-C2 transarticular screws to a wired contoured rod construct where C1 is included only slightly improves stability. As the absolute reduction in motion from adding transarticular screws is small (<1 degree), it is doubtful whether any enhanced fusion from this additional procedure outweighs the surgical risks. However, transarticular screws provide an effective alternate method to fixate C1 when the posterior arch of C1 is absent or has been fractured.
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Long-term results of patients treated with conventional laminoplasty have shown a significant number of patients complicated with kyphotic deformity. The authors hypothesize that by maintaining the spinous process-ligament-muscle complex (SPLMC) during laminoplasty, followed by postoperative muscle strengthening exercises, the formation of kyphosis can be decreased. ⋯ Laminoplasty with preservation of the SPLMC followed by appropriate postoperative muscle exercises may be an encouraging way to maintain or restore the physiological curve and prevent kyphotic deformity at a medium term follow-up.
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Meta Analysis Comparative Study
The safety of instrumented outpatient anterior cervical discectomy and fusion.
Reported hospitalization times after an anterior cervical discectomy and fusion (ACDF) procedure range between 20 hours to 4 days. Reasons for this wide variation are manifold, but the safety of an instrumented ACDF in the setting of a hostile medical-legal climate is most likely the primary concern influencing such a discrepancy. ⋯ Performing ACDF with instrumentation on an outpatient basis is feasible, and it is not associated with higher overall or hardware-related complication rates as compared with complication rates reported in the literature, suggesting that this procedure is safe to perform on an outpatient basis.
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Comparative Study
Biomechanical comparison of adjacent segmental motion after ventral cervical fixation with varying angles of lordosis.
Complications, such as graft subsidence and adjacent segment degeneration, are not uncommon after ventral cervical fusion. It has been theorized, but not proven, that sagittal alignment may affect this process. It is therefore hypothesized that increasing lordosis during anterior cervical fusion decreases adjacent segment motion (ASM) and thus decreases the rate of adjacent disc degeneration. A study was designed to test the first portion of this hypothesis; ie, that increasing lordosis during anterior cervical fusion decreases ASM. ⋯ Under the conditions of this study, there is a significant increase in ASM with the achievement of a modest increase in lordosis (small spacer) that is not observed with a greater increase in lordosis (large spacer).