The spine journal : official journal of the North American Spine Society
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Comparative Study
Compliance with clinical practice guidelines in family physicians managing worker's compensation board patients with acute lower back pain.
Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain. ⋯ Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians.
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Partial removal of the nucleus has been shown to decompress herniated discs, relieving pressure on nerve roots and, in some cases, offering relief from disc pain. The nucleoplasty technique builds on earlier surgical approaches that helped validate the strategy of intranuclear tissue removal. Nucleoplasty, a new minimally invasive procedure using patented coblation technology, combines coagulation and ablation for partial removal of the nucleus pulposus to decompress the disc. ⋯ The histologic findings of this study suggest that the nucleoplasty achieves volumetric removal of target disc tissue without overt thermal or structural damage to the adjacent tissues. Further studies in live animals will be needed to assess the effects of nucleoplasty on the annulus, end plate and neural tissues under physiologic conditions, including assessment of cell viability.
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Review Comparative Study
Lumbar intraspinal synovial cysts: conservative management and review of the world's literature.
Lumbar intraspinal synovial cysts are an important cause of axial and radicular spine pain. Controversy about nonsurgical versus surgical treatment persists. ⋯ In our opinion, nonsurgical management in patients with LISC-induced radicular pain does not appear to be as successful as surgery.
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Comparative Study
Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up.
Lateral mass plating has become the technique of choice for posterior cervical fixation. Although these systems are safe and reliable, they can be difficult to use in patients with abnormal cervical anatomy; screw placement can be compromised by the fixed hole spacing of the plate; screw back-out and other forms of implant failure can occur; and extension across the cervicothoracic junction can be problematic. ⋯ These data indicate that posterior cervical stabilization with polyaxial screw-rod fixation is a safe, straightforward technique that appears to offer some advantages over existing methods of fixation. Results appear to be durable at 1-year follow-up. Benefits are more significant with longer constructs, especially those extending to the occiput or crossing the cervicothoracic junction.