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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Comparative Study
Predicting outcomes of transforaminal epidural injections for sciatica.
Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. ⋯ When controlled for SSDI/workers' compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers' compensation and require heavy lifting at work.
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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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Spinal deformity surgery, like many other orthopedic procedures, involves significant operative blood loss. In order to avoid the necessity of bank blood transfusions, many blood management strategies have been devised. ⋯ The judicious use of the agents and techniques can significantly reduce the need for blood transfusions in the setting of spinal deformity surgery.