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Some additional terms related to cortisone injections for arthritis in back cheap 200 mg celebrex with amex mortality are burden of disease arthritis in dogs heat or cold cheap 200 mg celebrex with visa, life expectancy arthritis lyme order celebrex 200 mg line, and Epidemiologic Transition disability-adjusted life years treat arthritis naturally in dogs effective 100mg celebrex. In 2015, One refection of the epidemiologic transition the three leading countries for receiving international is the growing burden of chronic, degenerative dis migrants were the United States, Germany, and the eases, especially in developed countries and to a lesser Russian Federation. Toward the con ing countries communicable and infectious diseases clusion of 2015, more than 65 million persons were remain the leading causes of morbidity and mortality. Consequences of Population Increases and the degradation of sources of fresh water. The result is margin the levels of air, water, and other forms of pollution alization of small-scale farmers and pressure to increase. Also, the resources available per person on larger numbers to migrate from distressed decrease as the total number of individuals on the areas. In many cases the result is also the preva planet continues to increase geometrically. Population density Overtaxing carrying capacity (defned later in this and associated urban crowding are dimensions of envi chapter) ronmental degradation associated with increases in the Food insecurity spread of infectious and communicable diseases. Many developing Urbanization and the Environment countries, where population growth rates are among The past two centuries have seen a rapid increase in the highest in the world, are reaching the limit of their the number of cities over the entire globe. The United Nations Secretariat states that: 5% in 1800 to 50% in 2000 and is expected to reach excessive population pressure in specifc about 66% by 2030. Although the 14 Chapter 1 Introduction: the Environment At Risk Urban population by country income level, The factors that lead to urbanization include indus 1975-2015 trialization, availability of food, employment opportu 4,200,000 nities, lifestyle considerations, and escape from political confict. Among the most important causes of mor 2,800,000 bidity and early death in urban environments of devel oping countries are environmentally related diseases 2,100,000 and accidents. Residents therefore are ofen at risk from diseases and injuries asso High-income countries ciated with poor sanitation, unsafe drinking water, dangerous roads, polluted air, indoor Low-and middle-income countries 23(p1119) air pollution and toxic wastes. The term megacity denotes an urbanized area that proportion of urban residents has increased in both has 10 million or more inhabitants; in 2016, there were categories, a relatively larger growth in the num 31 megacities that contained slightly more than 6. This trend is apparent in the and their respective 2016 populations (in millions) fgure and is forecast to continue into the future. Biological pathogens or pollutants within the human environment that impair human health?including pathogenic agents and their vectors (and reservoirs); for instance, the many pathogenic microorganisms in human excreta, airborne pathogens (for instance, those responsible for acute respiratory infections and tuberculosis), and disease vectors such as malaria-carrying (Anopheline) mosquitoes 2. Chemical pollutants within the human environment, including those added to the environment by human activities. The availability, cost, and quality of natural resources on which human health depends?for instance, food, water, and fuel 4. Aspects of the built environment with negative consequences on physical or psychosocial health. National/global environmental degradation with more indirect but long-term infuences on human health Modifed and reproduced with permission from Satterthwaite D. Population and the Environment 15 Logistic growth, responding to immediate nega tive feedback, as carrying capacity is approached Domed or capped growth, responding to deferred negative feedback but necessitating a period of excess mortality Irruptive growth, with a chaotic post-crash pattern. Megacities have major infuences upon the environ If these components of the human life support sys ment in a number of ways. In 1798, Tomas Malthus authored First Essay Carrying Capacity on Population, which theorized that the human pop ulation had the potential to grow exponentially. Malthus suggested that pos populations may be threatened with disastrous conse itive checks? for excessive population growth rates quences when available resources are exhausted. The growth of the popu tible to depletion of nutriments and to poisoning by lation could be constrained also through preventive our own waste products. Endangerment of the human population through ecological damage is not far fetched: Previous history Animal Populations has recorded incidents of decimation and collapse of In the animal kingdom, the carrying capacity of an envi civilizations that were associated with disruption of the ronment governs population size. It is believed that approximately 5,000 of food availability, reproductive behavior, and infec years ago, Mesopotamia, a renowned ancient civiliza tious diseases tend to keep animal populations in check. In the interval as a source of meat for personnel on the island; however, between the 13th and 16th centuries, global tempera no deer were ever culled and all 29 remained when the tures declined by approximately 1?C (1. An abundance of deer fodder was available uting to the decimation of societies that were located on the island. Soon aferward, as a result of overgrazing and depletion of food sources for the deer, the population?having declined to fewer than Food Insecurity and Famine 50 animals in 1966?faced extinction. The term food insecurity refers to a situation in In a given area, the growth of animal populations which supplies of wholesome foods are uncertain or appears to be sequenced according to the following may have limited availability. Food insecurity and characteristic patterns: famine may occur when the carrying capacity in a 16 Chapter 1 Introduction: the Environment At Risk particular geographic area is exceeded. An illustration ecological community and ultimately determine its of the efect of exceeding the carrying capacity in a form and survival. Examples of physical environ sistence crisis, which follows when the ability of land mental factors (as noted previously) that afect human and available water to produce food are overtaxed. Tese factors will be discussed in to increase so that mortality is brought into balance more detail later in the text. Period The term environment captures the notion of fac ically, food insecurity is a reality in some developing tors that are external to the individual, as opposed to regions. For example, food insecurity endangers as internal factors such as genetic makeup. In contrast much as one-third of Africa, and the prognosis for to the physical environment, described in the forego increasing the food supply in some African countries ing defnition, the social environment encompasses is poor. Among the major determinants of health are the environment (physical and social), Loss of Biodiversity personal lifestyle factors, constitutional factors such as The word biodiversity is formed from the combination heredity and human biology, and healthcare systems of biological and diversity. An adequate defnition of dimensions such as access to and quality of medical biodiversity is not readily available. Nevertheless, the care and methods for organization of healthcare sys term biodiversity generally refers to the diferent tems. The dramatic human population growth during the past few decades and concomitant increases in urbanization and industrialization have caused the Ecological System (Ecosystem) physical environment to be degraded substantially; one Ecosystems are one of the important dimensions of the consequences of unchecked population growth of life in the biosphere. All life on earth survives in is hypothesized to be accelerated loss of biodiversity. The biosphere covers of harmful insect vectors, extinctions of species, and a narrow range from about 6 miles (9. Energy fows from the sun in the form of biodiversity is the destruction of tropical rain forests electromagnetic radiation. Defnitions Used in the into nutrients and oxygen via the process known as photosynthesis. This energy is then transferred to Environmental Health Field other life forms through the food chain, for example, via herbivores that eat the plants themselves or carni the Environment vores that eat other animals. The term environment refers to the complex of An ecosystem is a dynamic complex of plant, physical, chemical, and biotic factors (as climate, soil, animal, and microorganism communities and the and living things) that act upon an organism or an nonliving environment interacting as a functional Defnitions Used in the Environmental Health Field 17 m k Innate individual traits: age, sex, race, and Over the life span biological factors the biology of disease Living and working conditions may include. Educating Public Health Professionals for the 21st Century, 2003 by the National Academy of Sciences, courtesy of the National Academies Press, Washington, D. Eco Environmental Health systems vary enormously in size: a temporary pond The feld of environmental health has a broad focus in a tree hollow and an ocean basin can both be eco 32(p3) and includes a number of subspecializations. Degradation of eco ment and control of those environmental systems poses environmental dangers such as loss of factors that can potentially afect health. It is the oxygen-producing capacity of plants and loss of targeted towards preventing disease and cre biodiversity. Negative human impacts on the environment are Many of the principles identifed by Hippocrates thought to have begun many thousands of years ago. Consistent ancient Greeks are noteworthy for the history of envi with the belief that air is a factor in diseases is the ronmental health. Roman scholar Pliny the Elder (ce 29?79) during the Hippocrates, who lived between 460 and 370 1st century ce; Pliny invented a mask constructed bce, ofen is referred to as the father of medicine. Among their innovations were systems for the transport of water and sewage, heating devices for water and for rooms, and communal baths. As the city grew, a system of aque ducts that supplied fresh water and a web of sewers called cloacae were installed. The Romans used lead pipes to supply the homes of the afuent, who probably sufered from chronic lead poisoning. The period of approximately 1850 to 1950 was marked by growing awareness of existing threats to public health from unsanitary conditions, detrimental social conditions, and hazardous work environments. The British Par Occupational Health (Contributions from liament enacted the Public Health Act in 1848 to pro About 1500 to the Mid-1800s) mote clean water and control infectious diseases. Tere were major outbreaks of cholera, including an outbreak The feld of occupational health has made numer in New York City in 1849 that killed 5,000 people.
Her general medical conditions include hypothyroidism arthritis in the knee diagnosis order celebrex 200 mg otc, hypertension arthritis in the neck natural treatment order celebrex once a day, depression juvenile rheumatoid arthritis in feet order celebrex 100 mg with amex, osteoarthritis arthritis treatment vitamins discount celebrex 100mg online, chronic allergies, and atrial fibrillation. Medications include Synthroid (levothyroxine), hydrochlorothiazide, atenolol, amitryptiline, acetaminophen, Coumadin (warfarin), and Allegra (fexofenadine). External examination reveals an obese woman with prominent eyes due to a combination of shallow orbits, asymmetric lateral flare, lower lid retraction with several millimeters of scleral show, and mild inferior punctal ectropion. On slit lamp examination, all four lids have mild scurf on the lashes, with moderate atrophy and inspissation of the meibomian glands, and prominent telangiectasia of margins. The bulbar conjunctiva of the right eye reveals a large, diffuse bleb at 12 o?clock, with 360 degrees of chemosis from overfiltration. There is 2+ clear stringy mucus in the inferior cul-de-sac, and a mixed papillary and follicular reaction of the inferior palpebral conjunctiva. Eversion of the right upper lid shows a 4+ papillary reaction of the palpebral conjunctiva. The right cornea has a moderate superficial punctate epitheliopathy of the inferior 30%. Fluoroscein instillation confirms the exposure of the suture tail, and also reveals a moderate amount of fine, diffuse punctate staining of the elevated, chemotic conjunctiva. A mild dull pink appearance of the bulbar conjunctiva, with a small to moderate vascularized and encapsulated bleb at 11 o?clock. The lower lid palpebral conjunctiva has a 2+ follicular reaction and 1+ papillary reaction. Fluoroscein application does not reveal any additional abnormality of the conjunctiva. Obtaining and concisely organizing the pertinent history, which covers many years, would exceed the capabilities of most technicians. The multitude of findings reveals inflammatory changes due to multifactorial processes in each eye. There are the long-term toxic effects of glaucoma medications and their preservatives on the conjunctiva of both eyes, with the additional hypersensitivity reaction to brimonidine in the left eye. Multiple ocular surgeries, including two glaucoma filtering operations on the right eye, and the scleral buckle and filtration surgery on the left eye, cause significant periods of conjunctival inflammation, subsequent fibrosis, and long-term adverse effects on the cells and structures involved in the production and maintenance of a healthy tear film and ocular surface. In the right eye, two additional direct effects of the glaucoma surgery include the abnormal anatomic elevation of the conjunctiva due to overfiltration and chemosis, causing abnormal tear film dynamics with relative exposure and abnormal wetting, as well as the papillary conjunctivitis due to the exposed nylon suture irritating the upper palpebral conjunctiva. Both eyes have mild anterior blepharitis, as well as posterior lid disease, further contributing to the inflammatory milieu of the ocular surface. Amongst the systemic medical conditions was the history of Graves? disease with mild lid signs of flaring of the lateral canthi, and mild lower lid retraction, adding another potential evaporative dry eye component. Several of the systemic medications are known contributors to dry eye disease, including the diuretic, the antidepressant, and the antihistamine. This example of the complex interaction of numerous conditions with the resultant nonspecific sign of conjunctival injection underscores why one cannot try to follow an algorithmic flowchart to arrive at the correct diagnosis. There are often multiple conditions that must be identified and considered in terms of potential contribution to the overall end result of redness. Characteristics such as personal hygiene, body weight, and habitus can provide useful information, especially in patients who are poor historians. Body structures should be observed for structural changes secondary to systemic diseases, such as the hands and skin in rheumatoid arthritis or scleroderma. Many causes of red eye can be overlooked if one immediately zooms in? with the high-power view of the slit lamp. The skin of the lids and ocular adnexa is examined for signs of inflammation, past or recent trauma, scarring, unusual pigmentation, scaling, oil content, and texture. The presence of exophthalmos, either bilateral or unilateral, may be accompanied by injected conjunctival vessels and give definitive clues to the etiology. In addition to the more frequently occurring problem of thyroid-related eye disease, a number of uncommon orbital and intracranial conditions may present as a red eye because of either congestion or exposure of vessels of the globe. A partial list includes hemangiomas, arteriovenous malformations, lacrimal gland tumors, metastatic tumors, and mucoceles. Palpation for masses as well as for areas of tenderness along the lid margins, lacrimal gland, and lacrimal sac can be performed if entities such as dacryoadenitis, canaliculitis, and dacryocystitis, in addition to tumors of these structures, are suspected. Enlarged preauricular nodes may be present in cases of viral or chlamydial infection or, rarely, in cases of ocular or orbital malignancy. Examination of the facial features is followed by evaluation of the eyelids for abnormalities in structure or function. Particularly in cases of long-standing unilateral or asymmetric red eye problems it is not rare to detect a problem of the lids or adnexa that has been overlooked by others. Structural abnormalities can be due to past trauma, or prior oculoplastic surgeries (cosmetic or functional), or frequently from age-related involutional changes of the eyelids and adnexal structures. The presence of upper eyelid lash ptosis, often accompanied by mild upper lid ptosis, are frequently missed signs of floppy eyelid syndrome. Instructing the patient to squeeze the lids tightly closed can reveal an intermittent, covert spastic entropion or, less commonly, imbrication. Imbrication is the abnormal sliding of the upper lid over the external margin of the lower lid, resulting in mechanical irritation of the palpebral conjunctiva of the upper lid. It is most likely to occur after horizontal lid tightening procedures, particularly if the lower lid tightness is much greater than that of the upper lid. The chronic irritation produces a papillary reaction, increased mucus formation, and ocular surface inflammation. The history frequently is of a chronic conjunctivitis with production of stringy white mucus. It can be quite helpful to ask the patient to describe or demonstrate exactly how he removes the mucus. Typically, the patient is mechanically wiping or touching the inferior fornix and palpebral conjunctiva with a cloth, tissue, or cotton-tipped applicator, etc. Findings may include greater distractability of the lower lid of the affected eye, along with a papillary reaction of the inferior palpebral conjunctiva. Observing for asymmetry of the lower lid tear menisci during the initial general inspection can reveal a clue of underlying nasolacrimal outflow dysfunction. The patient may have a history of recurrent unilateral conjuctivitis, which improves with topical antibiotic treatment. Epiphora may or may not be significant, and sometimes will not be appreciated or mentioned by the patient during episodes because the other signs and symptoms of redness and discharge are of more prominence and concern. If the patient is referred, the episode of conjunctivitis may be resolved by the time of appointment, and the tear meniscus asymmetry may provide one of the few clues that leads to further evaluation of the nasolacrimal drainage system. Although acquired stenosis or obstruction anywhere along the pathway is a more common etiology, a large number of other causes is possible, ranging from infectious canaliculitis, to benign or malignant tumors intrinsic or extrinsic to the nasolacrimal system. Once the face and ocular adnexa have been examined, one continues without magnification by looking at the globes, fornices, and palpebral conjunctivae. The lower lids are first gently retracted manually, then the upper eyelids are lifted. If floppy eyelid syndrome is suspected, it is easier to demonstrate asymmetric laxity by instructing the patient to gaze inferiorly while the examiner uses the thumb of each hand to lift the upper lids simultaneously. Significantly floppy eyelids will evert rather easily, and usually reveal a marked papillary reaction. Another oft-missed condition that is relatively easily diagnosed with this step is superior limbic keratoconjunctivitis. The classic superior quadrantic bulbar conjunctival injection is much easier to detect without magnification. This is true also for assessing other conjunctival, episcleral, and scleral processes. Areas of scleral thinning may appear bluish-black due to the visibility of the underlying choroid, indicating possible past episodes of scleritis. Signs of ocular cicatricial pemphigoid, such as subconjunctival fibrosis, forniceal shortening, and symblephara are also less easily missed with unaided visual inspection. Functional eyelid problems refers to conditions where the eyelid anatomy is normal, but function is abnormal. Examples include seventh nerve pareses from any cause (postviral, postsurgical, trauma, stroke, etc. Such patients often have multiple possible contributing factors for a red eye or eyes, chief among which include evaporative dry eye and exposure keratoconjunctivitis.
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If repeated radiofrequency denervation is to test for arthritis in the knee buy celebrex cheap online be offered rheumatoid arthritis cure zone buy cheap celebrex online, we need to arthritis pain joint cheap celebrex 200mg free shipping be more certain that this intervention is both effective and cost effective arthritis knuckles cheap celebrex 100mg without a prescription. WhWhy this is importanty this is important Epidural injection of treatments, including corticosteroids, is commonly offered to people with sciatica. Epidural injection might improve symptoms, reduce disability and speed up return to normal activities. Several different procedures have been developed for epidural delivery of corticosteroids. Some practitioners inject through the caudal opening to the spinal canal in the sacrum (caudal epidural), but others inject through the foraminal space at the presumed level of nerve root irritation (transforaminal epidural). Some people believe transforaminal epidurals might be most effective because they deliver corticosteroids directly to the region where the nerve root might be compromised. But because transforaminal epidural injection needs imaging, usually within a specialist setting, this potentially limits treatment access and increases costs. Caudal epidural injection can be done without imaging, or with ultrasound guidance in a non-specialist setting. Use of the 2 methods varies between healthcare providers, and people whose sciatica does not respond to caudal corticosteroid injection might go on to have image-guided epidural injection. WhWhy this is importanty this is important An increasing number of procedures have been proposed for surgically managing low back pain. One of these procedures is surgical fxation with internal metalwork applied from the back, front, side, or any combination of the 3 routes. The cost of these operations has risen, and now that minimally invasive approaches are used, more of these operations are done with uncertain beneft. As well as the cost, surgery can lead to complications some studies report around a 20% complication rate in the short to medium term. There have been several studies (both randomised and cohort) looking at the clinical effectiveness of spinal fusion versus usual care, no surgery, different surgeries, and other treatments. Overall, the studies do not show a clear advantage of fusion but do show some modest beneft for some elements of pain, function and quality of life. The evidence from the studies was weak because of low numbers of patients, large crossover and in-case selection bias. This means there is a need for a large, multicentre randomised trial with suffcient power to answer these important questions. You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work) Non-commercial. If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one. One way to do this is with a link to the license web page: creativecommons. The last decade has seen a rapid advance in the management options available to the gynaecologist in treating women with pelvic foor dysfunction. Overactive bladder has seen the launch of a number of new anticholinergic drugs with better side-effect profles and dosing schedules. We also now have some alternatives to the drugs including Botulinum Toxin A and neuromodulation. We are developing a greater understanding of the role of childbirth and pregnancy in pelvic foor dysfunction. The last three years has seen the launch of intriguing pelvic foor replacement systems and although we are some way off from achieving long term data on these devices, this is no doubt an important step in the evolution of pelvic foor surgery. This book has been written by a number of authors from different parts of South Africa. The feld of urogynaecology is still in its infancy and we therefore have many unanswered questions. There is a signifcant amount of overlap and difference of opinion and we hope this will stimulate the reader to read widely and formulate his or her own opinion. The electronic format of this text has made it possible to offer it to the reader at an affordable price. We trust that this book will contribute to a better understanding and management of South African women with pelvic foor dysfunction. A special thanks to Robertha and Anthea Abrahams for secretarial work, and Dr Julie van den Berg for assistance with proof reading. The Editors 2 Chapter 1 the Urogynaecological History Stephen Jeffery Pelvic foor dysfunction is the doctor have been shown to be associated with multiple fraught with subjective infuences. In now available which are able to addition, women may present elicit symptoms in a standardised with neurological symptoms, form and quantify them. This is psychological issues and particularly useful in a research relationship dysfunction. It is setting but these instruments therefore imperative that the are now increasingly being history and examination are used in day-to-day practice. Clinical assessment therefore History aims to determine the extent of the impairment on quality of life Urinary Symptoms and thereby institute the most appropriate route of investigation Frequency and management. Normal Clinicians use the traditional frequency is considered to be approach of history and between four and seven voids a examination. This varies with the age Urgency Incontinence of the woman, with an increase Here, the women describes the reported in woman above the age symptoms of urgency and she is of 70 years where normal would unable to get to the toilet in time be considered to be twice at night, and develops incontinence as a three times for women over 80 result. Determining the severity of Incontinence Incontinence It is important to make a clinical Symptoms of Urinary Incontinence attempt to determine the severity are notoriously diffcult to of the incontinence symptoms. The International woman could be asked to quantify Continence Society defnes the symptoms on a scale of 0 to this as the involuntary loss I0. The Urinary urgency number of incontinence episodes this is the compelling desire to per day can also be indicative of void which is diffcult to defer. It must be differentiated from urinary urge which is a normal Symptoms of voiding desire to void which can be dysfunction 4 these symptoms are not as common in women as in men Prolapse symptoms but if present, should prompt Women with prolapse have a the appropriate investigation of broad range of symptoms. Pain that is Evaluation and questioning relieved with passing urine may regarding bowel symptoms is an be associated with Interstitial essential part of the evaluation of Cystitis/ Painful Bladder Syndrome. Women with pain as a signifcant symptom should be evaluated Anal Incontinence with cystoscopy and biopsy since this is the involuntary passage of pain may also be associated with fatus. Faecal Incontinence Urethral Pain this is defned as the involuntary this may be associated with passage of liquid or solid stool. This should be quantifed by asking the women about the frequency, Haematuria severity, use of continence aids Women with urinary symptoms and impact on quality of life. Medications A note should be made of Defaecatory dysfunction medications that may be Women should be asked about worsening the symptoms, including any diffculty in completing diuretics and alpha blockers. Medical History Diabetes Mellitis and Insipidus are Constipation usually associated with polyuria. A record should be made of Cardiac failure can present frequency of stools and any with nocturia as a result of the symptom of constipation. Sexual History A detailed history of sexual Fluid Intake function is vital to a thorough the amount and type of fuid assessment of pelvic foor consumed on a daily basis should disorders. Obstetric History the number and type of deliveries are important as well as any history of perineal or anal sphincter injury. Other relevant parts of the history Surgical History Previous pelvic surgery, including Neurological history prolapse and incontinence surgery, Women should be questioned should be noted. Any history of multiple sclerosis, parkinsonism, spinal cord injury, stroke or spina bifda should also 6 Causes of Incontinence I. Excessive urine production Diabetes Mellitis and Insipidus Diuretics Cardiac failure Adapted from Textbook of Female Urology and Urogynaecology Eds Cardozo and Staskin. Lower Lower urinary tract symptoms are urinary tract symptoms were categorized as storage, voiding defned by the standardization sub and post micturition symptoms. Symptoms may the complaint by the patient who either be volunteered or described considers that he/she voids too during the patient interview. In general, lower urinary tract Nocturia is the complaint that the 8 individual has to wake at night Stress urinary incontinence is the one or more times to void. Urgency urinary incontinence is the complaint of involuntary leakage Urinary incontinence is the accompanied by or immediately complaint of any involuntary preceded by urgency. If it is used to denote leakage, and whether or not the incontinence during sleep, it individual seeks or desires help should always be qualifed with because of urinary incontinence. Intermittent stream or Double voiding (Intermittency) is the term Continuous urinary incontinence used when the individual describes is the complaint of continuous urine fow which stops and starts, leakage and may denote urinary on one or more occasions, during fstula. Bladder sensation can be defned, Hesitancy is the term used when during history taking, into four an individual describes diffculty categories.
Associated underlying pathologies reported were Diabetes Mellitus (14) rheumatoid arthritis review purchase celebrex 100 mg with visa, smokers (7) rheumatoid arthritis toes order celebrex 200 mg, thyroid disease (3) arthritis in horses feet buy celebrex 200mg cheap. Patient reported outcomes were signifcantly improved after 6 months and outcomes were maintained or improved at the latest follow-up what causes arthritis in your back buy celebrex 200mg mastercard. Complications noted were: Hardware failure (3), wound disruption (1), infection (1), new radicular pain (1), and listhesis (1); all complications are associated to a combination of obesity and/or underlying pathologies; all complications required re-interventions. These Results: the resistance of the motion segment to results indicate that this procedure can minimize the distraction forces dropped 37. Furthermore, long-term discectomy, resistance of the motion segment further Questons? Conclusions: We have developed a new, accurate, and reproducible method for measuring lumbar instability that is useful during surgical procedures without changing the surgical strategies or adding risk. Our preliminary results highlight the stabilizing roles of the different anatomical structures of the motion segment, awarding a real and objective value to each structure. These results demonstrate the importance of the supraspinous ligament and annulus as the main structures resisting sagittal fexion of the lumbar motion segment. A Novel Approach to a Challenging Clinical Scenario Conclusions: We report a series of patients that Revision Surgery for L5-S1 Pseudoarthrosis underwent a revision novel technique for symptomatic D. The data Background: Pseudoarthrosis at L5-S1 is a relatively suggest that this technique should be considered as an common problem following long fusion to the sacrum. Here we present the Lumbar Therapies and Outcomes technique, radiographic and clinical outcomes of a series of patients that underwent a novel method for revision L5-S1 interbody fusion. Completely non fused fxation was done in 40 patients while 67 underwent hybrid fusions. Parameters of sitting time and walking distance vertebrae during the procedure and can be dangerous were obtained. The bench-top pullout testing showed that this patients were available at fnal follow-up. Both walking and sitting ability had been caused by disc degeneration disease at C3-C7 levels. This study reports our early clinical experience on our Hardware failure was seen in 11% of cases, only 2% frst 11 Chinese patients using NuNec artifcial cervical (19/660) of screws. Re-operations were needed in 9 patients, of which only 5 the patient age ranged from 23 to 67 years old. An anterior approach was used to implant the NuNec Surgical time was only 74 minutes, blood loss 334 device. There was no major intra-op and post-op complication Conclusion: Cosmic non-fusion fxation was safe and occurred in this series. In the follow-ups ranged from reliable, had few complications and had less morbidity 3 to 6 months, patients experienced signifcant pain than convensional fusion, with only 2% adjacent level reduction and functional improvement as measured by break down requiring surgery. Radiograph images showed no dislocation of the implant and maintaining of the normal range of motion. In conclusion, this early clinical experience on NuNec suggested that the device is safe and effective. Many of 485 the design benefts have been demonstrated through this Early Clinical Experience of NuNec Artifcial Cervical early clinical study. This warrants further expansion of Disc 1 clinical study with more patients and longer follow-ups. A novel cervical disc Minimize Soft Tissue Infltration Following Lumbar arthroplasty device, NuNec, has been developed recently Spinal Fusion Surgery and its early clinical experience on this device will be C. Most other cervical artifcial discs either are attention has been given to chitosan-based materials made of all metals or contain two metal plates which are in the feld of orthopedic tissue engineering. It is to our knowledge that NuNec is the frst radiolucent Methods: One titanium cage with collagen and one articulating artifcial cervical disc. In implanted in vertebral wings L3-4 in six pigs (Lanyu order to fx the endplates of artifcial disc to the adjacent 300, Taitung, Taiwan). The following procedures would be Spondylolisthesis reduction, discectomy and interbody fusion. Clinical Application of Posterior Paramedian Signifcant difference is discovered(P< 0. Conclusion: Applying low back surgery through Objective: Though traditional posterior median approach posterior para-median approach has the advantage of is widely used in spine surgery, reports of its application lowering the surgical diffculty of implantation, reducing in low back surgery and its advantages/disadvantages in the risk of nerve damage and is also a minimum invasive laminectomy decompression are seldom seen. In many cases, laminectomy is unnecessary, clinical complications due to the defects of this traditional leaving the lamina intact could preserve the physiological approach are misplacement of pedicle screws or other anatomy of the spine. Retracting the canal space after laminectomy to perform intervertebral fusion could also cause nerve 489 damage. Hence,for a segmental structure suffered with disability due to remaining back pain like the spinal canal, excluding conditions such as even after these procedures. Laminoforaminotomy for Degenerative Materials and methods: this is a retrospective, Radiculopathy A Comparison with Published single institution, matched-pair study with minimum Results Following Anterior Cervical Decompression 1-year follow-up. Based on age, gender, preoperative bone radiculopathy caused by cervical degenerative disease, since frst described by Spurling & Scoville in 19441. Mean age was 52 years, until 6 week and became similar to each other at 6 month compared with 44 years for the 1213 patients reported in and 1 year postoperatively. Pelton1 apparent that operative time and profciency does rapidly 1Rush University Medical Center, Orthopaedic Surgery, improve in adapting to a minimally invasive technique. Only those patients that were single level, primary surgeries were included (Table 1). Every patient had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Patients underwent a laminectomy with bilateral [Table 1 and 2] facetectomy and foraminotomy using a 21mm non expandable tube with unilateral pedicle screw fxation and a single intervertebral cage. Posterior Shifting Pattern of Spinal Cord Following Methods: Patients were analyzed chronologically from Cervical Open-door Laminoplasty the date of surgery. Dang1 the study cohort was split in half based upon the 1Peking University Third Hospital, Beijing, China initial date of surgery. Estimated blood loss was also myelopathy were performed open door laminoplasty signifcantly greater in the frst group. Parameters indicating shift distance of anesthesia were greater in the frst group than the of cord and dura, local curvature at each level, and the second (p < 0. There were no signifcant differences overall curvature of cervical spine were determined. T1-T12 and T1-S1 length increased Results: the anterior margin of dura rarely changed by 11% and 12. According to this 502 mechanism, decompression range for laminoplasty Direct Neurologic Decompression Improves can be selected according to compression segments; Functional Neurologic Outcomes in Spinal Stenosis although the cervical curvature is straight or slight and Low-grade Spondylolisthesis: A Comparison of kyphosis, the cord may still shift signifcantly. Potaczek 1Jagiellonian University, Faculty of Medicine, Department of grade degenerative spondylolisthesis. Mean decompression and cofex? interlaminar stabilization or curve preoperatively was 87. We evaluated course laminectomy and posterolateral spinal fusion with spinal of surgery, number of additional interventions, obtained instrumentation in a 2: 1 ratio. Results: the implantation procedure was uneventful the primary outcome measure was Zurich Claudication in all cases, mean blood loss-55ml,surgery time Questionnaire, a patient-reported validated functional 82 minutes. Three cases of early complications outcomes instrument for spinal stenosis and neurogenic were noted: one screw pull-out, two cases of hook claudication. There were no signifcant differences between the Methods: Actual cost of care data was available for cofex? and fusion cohorts (p=0. Our data suggest the potential Biomechanics/ Basic Science for substantial cost-savings, without compromising clinical outcomes, with cofex? interlaminar stabilization 511 compared with fusion in the treatment of spinal stenosis Does Applying Normal Saline Signifcantly Change and spondylolisthesis. The base 1Loma Linda University Medical Center, Orthopedic Surgery, of the adhesives is cyanoacrylate. In the surgical setting, moisture Background and purpose: Several topical adhesives on the skin surface starts the polymerization. Many of these have been application of water or saline has been used anecdotally used in spine surgery as a topical dressings. Cyanoacrylate rapidly wound bursting strengths between different products, but polymerizes in the presence of water or hydroxide ions to none have looked at whether applying saline changes bond surfaces together. The Hypothesis: Null-Hypothesis the addition of Normal application of water or saline has been used anecdotally Saline to cyanoacrylates during curing does not to speed the curing time, however no studies to date change the wound bursting or cohesive strength. Test-Hypothesis the addition of Normal Saline to Hypothesis: Null-Hypothesis the addition of Normal cyanoacrylates during curing does change the wound Saline to cyanoacrylates during curing does not change bursting or cohesive strength.