The spine journal : official journal of the North American Spine Society
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Fractures of the sacrum are a rare complication following instrumented spinal fusion, with only 34 cases previously reported in the literature. Previous series have generally been limited to less than five cases. ⋯ Sacral fractures following instrumented posterior spinal fusion are an uncommon complication; that is often unrecognized on plain radiographs. Risk factors include osteoporosis and long spinal fusions. Anterolisthesis and kyphosis of the fracture is associated with failure of conservative management.
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Case Reports
"Artifactual fracture-subluxation" of cervical spine in computed tomography screening sans plain radiographs.
Computed tomography (CT) has become the sole modality of screening for cervical injury in polytrauma because of the high sensitivity, speed, and convenience, thereby eliminating the need for plain radiographs. ⋯ Motion artifact in cervical CT screening can lead to a misdiagnosis of fracture subluxation. Duplication of soft tissue is highly suggestive of this motion artifact, and an additional single lateral plain radiograph may avert this pitfall.
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After decades of clinical research, the role of surgery for chronic nonspecific low back pain (CNLBP) remains equivocal. Despite significant intellectual, human, and economic investments into randomized controlled trials (RCTs) in the past two decades, the role of surgery in the treatment for CNLBP has not been clarified. ⋯ The research agenda of RCTs for surgery of CNLBP has not changed substantially in the last 20 years. Technical trials evaluating nuances of surgical techniques significantly predominate. Despite the publication of four RCTs reporting equivocal benefits of surgery for CNLBP between 2001 and 2006, there was no change in the research agenda of subsequent RCTs, and technical trials continued to outnumber indication trials. Rather than clarifying what, if any, indications for surgery exist, investigators in the field continue to analyze variations in surgical technique, which will probably have relatively little impact on patient outcomes. As a result, clinicians unfortunately have little evidence to advise patients regarding surgical intervention for CNLBP.
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Randomized Controlled Trial Comparative Study
Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.
Chronic low back pain (cLBP) represents a major challenge to our health care systems. The relative efficacy of surgery over nonoperative treatment for the treatment of cLBP remains controversial, and little is known of the long-term comparative outcomes. ⋯ After an average of 11 years follow-up, there was no difference in patient self-rated outcomes between fusion and multidisciplinary cognitive-behavioral and exercise rehabilitation for cLBP. The results suggest that, given the increased risks of surgery and the lack of deterioration in nonoperative outcomes over time, the use of lumbar fusion in cLBP patients should not be favored in health care systems where multidisciplinary cognitive-behavioral and exercise rehabilitation programmes are available.
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Pain innate to intervertebral disc, often referred to as discogenic pain, is suspected by some authors to be the major source of chronic low back and neck pain. Current management of suspected discogenic pain lacks standardized diagnosis, treatment, and terminology. ⋯ Our findings show that suspected discogenic pain, despite its extensive affirmation in the literature and enormous resources regularly devoted to it, currently lacks clear diagnostic criteria and uniform treatment or terminology.