The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial Clinical Trial
Effects of aerobic exercise on low back pain patients in treatment.
Aerobic exercise (AE) has been prescribed to improve fitness and well-being in apparently healthy individuals and cardiac, orthopedic, and other patient populations. AE has not previously been studied as a sole treatment for low back pain patients (LBPP). ⋯ Low to moderate aerobic exercise appears to improve mood states and work status and reduce the need for physical therapy referrals and pain medication prescriptions for LBPP in the care of a neurosurgeon.
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Multicenter Study Clinical Trial
Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion.
A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates. ⋯ The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.
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Back pain is the single most costly work-related injury. Chiropractors and physicians are the main primary care providers for occupational low back pain (OLBP), but there is no consensus regarding the relative cost-effectiveness of these two modes of care. ⋯ Existing studies fail to clarify whether medical or chiropractic care is more cost effective. We suggest that future studies must combine epidemiologic and economic methods to answer the question adequately.
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Clinical Trial
Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis.
Pedicle screw fixation in osteoporotic bone and in revision of previous pedicle screw fixation cases presents a significant challenge to spine surgeons. Biomechanical tests have shown that a pedicle screw that expands within the vertebrae body can substantially improve fixation in the presence of compromised bone. ⋯ The results of this study have shown that expandable pedicle screws can be efficacious in cases in which pedicle screw fixation is difficult and adds a valuable tool to the growing armamentarium of spinal instrumentation.
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Autogenous posterolateral fusion with and without instrumentation has been reported with good results. However, difficult-to-fuse patients, such as smokers, elderly patients with poor bone quality and/or quantity, or patients with prior posterior surgeries, may have somewhat lower fusion rates. ⋯ Based on this small retrospective review, coralline hydroxyapatite is an effective bone graft extender in difficult-to-fuse patients as an adjunct to autologous bone for posterolateral fusion of the lumbar spine when combined with rigid instrumentation.