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In the study conducted by Lock and Aronson [27] high lumbar level of paralysis was found most often, in 15/37 MMC patients who suffered fractures (41%).
Demographic data and the level of paralysis, divided into thoracic, high lumbar (L1−3), low lumbar (L4/5), and sacral, were reviewed.
Among these 862 patients, the level of paralysis was nearly equally distributed among thoracic (31.3%), high lumbar (28.8%), and low lumbar (33.2%), whereas nearly 60% of the patients treated for a fracture were paralyzed at the thoracic level (Table 3).
Spinal fusion is the treatment of choice for a number of lumbar diseases, and has advantages such as predictable outcomes, low recurrence rate, and high lumbar spine stability.
Visser et al. concluded that the intervertebral level is a statistically significant factor in the distribution of sensory blockade, and a low thoracic insertion was shown to cause less motor blockade than a high lumbar epidural approach [ 15].
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One of the main reasons for a higher prevalence of thoracic-level and high lumbar-level paralysis might be the pronounced osteoporosis that develops in MMC patients due to the lack of vertical load [1, 9, 14, 21, 24, 25, 29, 35, 36].
No significant difference was seen in bone parameters between control and treatment groups except for a lower Dpyr in the high soy and a higher lumbar BMD in the low soy groups.
Zhang et al. [107] demonstrated that individuals receiving both pharmacological treatment (antiresorptive drugs) and exercise had higher lumbar spine BMD than individuals treated only with antiresorptive agents.
Femoral neck BMD is higher in men with CAGS+GGNS haplotypes, whilst men harboring CAGL+GGNL haplotypes have the higher lumbar spine BMC and BMD.
Men harboring the combination CAGL+GGNL had 6.3 and 4.4% higher lumbar spine BMC and BMD than men with the haplotype CAGS+GGNS (both P<0.05).
Men harboring the combination CAGL+GGNL had 6.3% higher lumbar spine BMC than men with the haplotype CAGS+GGNS (P<0.05) (Fig. 2).
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