The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial Comparative Study
Comparison of usual surgical advice versus a nonaggravating six-month gym-based exercise rehabilitation program post-lumbar discectomy: results at one-year follow-up.
Discectomy is the surgery of choice for the lumbosacral radicular syndrome. Previous studies on the postsurgical management of these cases compare one exercise regime to another. This study compares an exercise-based group with a control group involving no formal exercise or rehabilitation. ⋯ There was no statistical advantage gained by the group that performed the 6-month supervised nonaggravating exercise program at 1-year follow-up. They did, however, have fewer days off work.
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Comparative Study
Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis?
Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use. There are no long-term studies comparing these two techniques. ⋯ We were unable to demonstrate any significant advantage for the use of anterior titanium interbody cages over the use of morselized rib graft in the surgical management of Scheuermann's kyphosis. Given the not inconsiderable cost and the need for posterior chevron osteotomies when interbody cages are used, we have now reverted to our previous practice of using morselized rib graft at each intervertebral level.
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Comparative Study
A survey: conscious sedation with epidural and zygapophyseal injections: is it necessary?
Substantial variation exists regarding the use of sedation before interventional spine techniques. Patient preference should play an important role in decision making regarding the need for sedation. However, little is known about patients' anxiety levels before spinal injections and their perceptions about the necessity of sedation. ⋯ Routine sedation before diagnostic and therapeutic injections is not necessary as the majority of patients would not request sedation before the procedure when given the option. However, in some patients sedation is indicated, and all patients would benefit from educational material on sedation before the injection.
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Only controlled intra-articular zygapophyseal joint (ZJ) injections or medial branch blocks can diagnose ZJ-mediated low back pain. The low prevalence of ZJ pain implies that identification of clinical predictors of a positive response to a screening block is needed. ⋯ A negative extension rotation test, the centralization phenomenon, and four CPRs effectively rule out pain ablation after screening ZJ block. One CPR generates a fivefold improvement in posttest probability of a negative or positive response to ZJ block.
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Multiple bone graft substitutes for spinal fusion have been studied with varying results. ⋯ Mineralized collagen bone graft substitute exhibited similar radiographic results compared with autograft in this model. Further trials incorporating bilateral fusion, as well as posterolateral fusion alone without interbody fusion are warranted to confirm the results of this study.