The spine journal : official journal of the North American Spine Society
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Biomechanical studies have demonstrated increased motion in motion segments adjacent to instrumentation or arthrodesis. The effects of different configurations of hook and pedicle screw instrumentation on the biomechanical behaviors of adjacent segments have not been well documented. ⋯ The use of sublaminar hooks to stabilize the motion segment above a circumferential lumbar fusion reduced motion at the next cephalad segment compared with a similar construct using pedicle screws. The semiconstrained hook enhancement may be considered if a patient is at a risk of adjacent segment disorders.
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Case Reports
Neurogenic claudication and radiculopathy as delayed presentations of retained spinal bullet.
Firearm injuries to the spine may cause injury to the neurological structures and/or to the spine, including ligaments and bones. ⋯ These cases illustrate that retained intraspinal bullets can present with delayed neurological findings secondary to reactive changes around the bullet.
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Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear. ⋯ This review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.
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Report the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI). ⋯ The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID.
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Comparative Study
Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion.
Multilevel lumbar disc disease (MLDD) is a common finding in many patients. Surgical solutions for MLDD include fusion or disc replacement. The hybrid model, combining fusion and disc replacement, is a potential alternative for patients who require surgical intervention at both L5-S1 and L4-L5. The indications for this hybrid model could be posterior element insufficiency, severe facet pathology, calcified ligamentum flavum, and subarticular disease confirming spinal stenosis at L5-S1 level, or previous fusion surgery at L5-S1 and new symptomatic pathology at L4-L5. Biomechanical data of the hybrid model with the Maverick disc and anterior fusion are not available in the literature. ⋯ The Maverick disc preserved total motion but altered the motion pattern of the intact condition. This result is similar to unconstrained devices such as Charité. The motion at L4-L5 of the hybrid model is similar to that of two-level Maverick disc replacement. The fusion procedure using an anterior plate significantly reduced intact motion. Clinical studies are recommended to validate the efficacy of the hybrid model.