The spine journal : official journal of the North American Spine Society
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Longer life span has resulted in increased risk of vertebral osteoporotic fractures. Among minimally invasive procedures, percutaneous vertebroplasty (PV) has shown excellent results in the treatment of chronic vertebral pain. The role of preintervention bone single photon emission computed tomography-computed tomography (SPECT-CT) has not been clearly established for the management of these patients. ⋯ Positive bone SPECT-CT seems a good predictor of postprocedural response. It also adds valuable information as to the cause of back pain and facilitates complete patient evaluation in patients that can not receive MRI.
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Findings on imaging of noncontractile anatomic abnormalities and the intensity of low back pain have weak associations because of false-positive rates among asymptomatic individuals. This association might be stronger for contractile tissues. ⋯ The results of this study indicate that there was no association between the magnitude of muscle damage in the lumbar erector spinae and reported pain intensity in the low back. In future studies, larger cohorts may report statistically significant associations, but our data suggest that there will be low magnitude potentially indicating limited clinical relevance.
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Low back pain (LBP) is a symptom, not a diagnosis. The failure to differentiate underlying diagnoses in patients complaining of LBP is one of the primary reasons that studies examining treatments for LBP have yielded inconsistent results. To design a lumbar spine registry such that the accumulated data provide applicable guidance for clinical treatment, the incorporation of a functional diagnostic matrix is critical. ⋯ This study demonstrates that improved diagnostic stratification of lumbar spine disorders is a feasible goal. The diagnostic coding matrix, based on clinically relevant descriptors, yielded substantial interrater consistency for symptoms, moderate interrater consistency for structural and compressive pathology, and substantial intrarater consistency for all elements.
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Interventional spine procedures are commonly performed in the ambulatory surgical setting, often using conscious sedation. The rate of adverse events with conscious sedation has not been previously assessed in the interventional spine procedure setting. ⋯ The findings of this study suggest that mild to moderate conscious sedation in interventional spine procedures is associated with low rates of adverse events when established protocols are followed.
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During the last 120 years, several mechanisms to protect the spinal nerve against traction have been described. All the described structures were located inside the spinal canal proximal to the intervertebral foramen. Ligaments with a comparable function just outside the intervertebral foramen are mentioned ephemerally. No studies are available about ligamentous attachments of cervical spinal nerves to adjacent vertebrae. ⋯ At the cervical level, direct ligamentous connections exist between extraforaminal cervical spinal nerves and nearby structures. They may serve as a protective mechanism against traction. In addition, these ligaments play an important role in the positioning of the nerves in the intervertebral foramen.