J Chiropr Med. He also noted improved tolerance to walking and standing (30min vs 10min at the initial consultation). When patients ask me for advice on how to know if you have a spinal disc problem, theres a story that comes to mind Waterbeds were something else, werent they? Absolutely! 2016- left c4/5 foraminotomy. Articles Chiropractic BioPhysics [], CBP Seminars, Inc. He denied bowel or bladder retention or incontinence, saddle anesthesia, fever, chills, nausea, vomiting, unexpected weight change, change in symptoms with coughing, sneezing, or bearing down, or abdominal complaints. You will then receive an email that helps you regain access. Spinal cord stimulator devices are comprised of a programmer, a pulse generator, an extension cable and electrode leads; leads can be percutaneous, paddle or hybrid leads [3]. 2004;3(3):10815. Get the latest health tips to your inbox, 2008 FindaTopDoc.com - Privacy Policy - Archive - Find the Right Doctor for You. No changes were noted in opiate usage. In chiropractic care, manipulations are intended to adjust or realign bones in your spine or other body parts. 2023 BioMed Central Ltd unless otherwise stated. Facet loading produced local low back pain bilaterally and bilateral sacroiliac provocation produced local non-concordant sacroiliac joint pain. The dysphagia usually resolves within days, but there is a risk that it can last weeks to months. At Ideal Spine, we frequently consult with patients post-surgery about the efficacy of spinal manipulations moving forward. The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician's advice or judgment. After the first year, you should consult with your surgeon and physical therapist to determine if the graft is strong enough to withstand chiropractic manipulation. This content does not have an English version. Using Game of Thrones to Explain Chiropractic Care, Multiple Sclerosis, Neck Trauma, and the Glymphatic System, The Delicious Recipe I Learned From the Creator of Dilbert, Pain at the base of the skull and lowest part of the neck. Nurses. 2007;10:2433. Need to login as a doctor? A CT of the lumbar spine demonstrated a T9-10 disc herniation without thecal sac encroachment, and a spinal cord stimulator with lead placement at T11-12. Learn How Bone Growth Therapy Can Help You, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts, Pain that worsens despite taking medication as prescribed, Numbness, weakness, or reduced bowel/bladder control, Increased redness, pain, or discharge at the incision site, Nausea, dizziness, severe headache, fever, or chills. Everyone gets headaches once in a while. The good news is you have several other regions in your spine that can still be adjusted, and you would likely benefit from those treatments. statement and Tired of dealing with pain and discomfort? Hypoesthesia was noted over the lateral right thigh and distal leg. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. can you go to chiropractor after cervical fusionthe lost boys remake cast By | aunt louie snowfall pregnant | mv6020 police report codes | 8 Thng Su, 2022 | 0 CAS Some chiropractors use an instrument (activator, arthrostim, impulse for example) thats lower force and doesnt require any twisting or cracking of the neck and those are safe to use on the neck. Spine J. Max Whitmore is a personal trainer with more than three years experience in individual and group fitness. If you think you have been blocked in error, contact the owner of this site for assistance. 2 Comments. In a perfect world, we would see people before they got to the point where spinal surgery was an option to see if we could prevent any serious invasive intervention. Spinal manipulation is performed by providing a high-velocity, low-amplitude (HVLA) thrust to a diarthrodial synovial joint. can you go to chiropractor after cervical fusion can you go to chiropractor after cervical fusion. Further investigation is needed to determine the appropriateness of spinal manipulation in patients with implanted spinal cord stimulators. can you go to chiropractor after cervical fusiongoleta pier fishing rules. J Manipulative Physiol Ther. Some people may prefer sleeping in a reclined position, such as a recliner chair, for the first few days. However, if you are in Hatboro, Warminster, Warrington, or Horsham and have gone through a neck or back surgery, then schedule an appointment to see how we can help you. J Manipulative Physiol Ther. You can also read the documentation to learn about Wordfence's blocking tools, or visit wordfence.com to learn more about Wordfence. Does Back Pain Always Mean Spinal Misalignment? Here are three things to know about neck mobility following an ACDF. Individuals who have had spinal fusion surgery should avoid going to a chiropractor within the first year post-surgery. Chiropractic treatment. Eventually, due to the persistent nature of his complaint, a spinal cord stimulator trial was undertaken to which he responded positively. Chiropr Osteopat. Over time, the bones graft together to immobilize that section of the spine. National Center for Complementary and Integrative Health. SCS has been found to significantly reduce pain, increase functional capacity, improve quality of life, reduce analgesic consumption, and allow patients to return to work [2, 6, 810]. We find that a good number of these fusion patients do extremely well with chiropractic adjustments and wish they would of started treatment years earlier so they could of gotten relief much sooner. After a spinal fusion surgery, it can take a minimum of three months for the vertebrae to fuse together and create a fully immobilized graft. Some trial and error may be necessary with pillows of different sizes or firmness before finding what works best. Eur Spine J. 2014;17:23546. If your symptoms don't begin to improve after several weeks of treatments, chiropractic adjustment might not be the best option for you. Watch: Pillows and Positions for Easing Neck Pain Video. If you are serious about your health and the health of your loved ones, contact a CBP trained provider today to see if you qualify for care. 2013;12:16875. Spinal fusion surgery is an orthopedic or neurosurgical procedure that joins two vertebrae together to create a fusion at a specific spinal level. CAS Most fusions are the lower cervical, and the levels above and below the fusion can be adjusted. Chiropractic adjustment is a procedure in which trained specialists (chiropractors) use their hands or a small instrument to apply a controlled, sudden force to a spinal joint. This is a great question that I get asked often while I am out speaking with people about chiropractic in the Montgomery County, PA community. PubMed Eur Spine J. Chiropractic adjustment can be effective in treating low back pain, although much of the research done shows only a modest benefit similar to the results of more-conventional treatments. Yes , after we examine you to determine which technique is best for you and your situation. Taking Charge of Your Health & Wellbeing. Diagnosis can't be done without an examination. CAS Lumbar spine range of motion was severely limited in flexion and mildly limited in extension with local low back pain in both directions. https://www.uptodate.com/contents/search. With multiple locations across the state of Utah, the pain management specialists at Southwest Spine and Pain Center are dedicated to helping those who suffer from chronic pain live the life they want to. The misconception stems from the fear that chiropractic care and neck or back adjustments will do harm to the surgically-affected areas. This site complies with the HONcode standard for trustworthy health information: verify here. PubMed Central Visualized is a series of two radiographs, including an anterioposterior view (a), and a lateral view (b), of a post-surgical lumbar spine with pedicle screw and rod fixation at L4-S1 levels, and spinal cord stimulator lead wires entering the spinal column at L1-2 with a pulse . During the adjustment, you may be asked to lie on a specially designed table. There is some debate as to whether you should have chiropractic manipulation after spinal fusion surgery 1. 1997;20:5115. Correspondence to After the graft is complete, another few months of physical therapy are usually necessary to strengthen the muscles around the graft. Copyright 2023 Leaf Group Ltd., all rights reserved. June 16, 2022 . National Health Statistics Report. Mayo Clinic; 2019. Taylor RS. al. Chiropractors don't hold an M.D, so they aren't medical doctors, but they graduate with a doctor of chiropractic degree. Yes, you can see a chiropractor after a cervical fusion surgery. Subsequently he underwent an L4/5 laminectomy and fusion in 2000. Looking for a CBP chiropractor in your area? Article Chiropractic care may also include exercise and lifestyle counseling. First, the controlled force and manipulation during a chiropractic session could reinjure the spine. Eur Spine J. Acute spinal fractures and malignant tumors are obvious contraindications to manipulation. PubMed Article At the time of presentation to our clinic, his low back pain was constant yet variable in intensity ranging from 3/10-8/10. To schedule an appointment, click here! Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Long-term poor mechanics will lead to the uneven wearing down of things such as the vertebrae and discs. Prior treatment had included the aforementioned surgical procedures, physical therapy, repeat lumbar epidural steroid injections, and opiate and non-opiate analgesics. Also work is done above and below the fusion.not on the fused area. Google Scholar. Bennett SE, Schenk RJ, Simmons ED. If You Suffer From Headaches or Migraines. Pain Management at Home after ACDF. Although every patient and procedure is different, it's best to wait up to 6 months before seeking alternative treatment modalities, including chiropractic care. He was treated 5 times over the next 4weeks reporting durable relief of his low back pain and bilateral lower extremity numbness and tingling to pre-injury levels. After your first chiropractor appointment, it's important to drink a lot of water. Estadt GM. Yes, you can; they will do an exam and possible X-ray to see fused segments. Accessed Oct. 6, 2020. Doctors of Chiropractic (DC) are licensed doctors who does diagnosis and either preforms and/or recommends treatment. Neuromodulation. I see and hear about this a lot now. https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know. 15(4):307-11. A 73year-old male presented with a history of chronic low back pain and right lower extremity pain, weakness and, numbness status post L4/5 laminectomy and fusion, and spinal cord stimulator implantation. Yes, you can see a chiropractor after a cervical fusion surgery. Get Veritas Health Newsletters delivered to your inbox. The effect of multilevel anterior cervical fusion on neck motion. National Center for Complementary and Integrative Health. Chiropractic is successful with many patients with spinal fusion. He stated that his symptoms were worst in the morning. Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. The patient was diagnosed with mechanical low back pain status post L3-4, L5-S1 fusion and spinal cord stimulator implantation. After the first year, you should consult with your surgeon and physical therapist to determine if the graft is strong enough to withstand chiropractic manipulation. A case report published in the 2009 "Journal of the Academy of Chiropractic Orthopedists" said that patients who experience continued pain after lumbar fusion responded well to a combination of spinal adjustment and distraction decompression. Accessed Sept. 28, 2020. A 57year-old male presented with a history of acute-on-chronic low back pain and bilateral lower extremity numbness and tingling status post spinal cord stimulator implantation. Life threatening complications are very rare [1], and neurological damage is uncommon [13]. A herniated disk or a worsening of an existing disk herniation, Compression of nerves in the lower spinal column, A certain type of stroke after neck manipulation, Numbness, tingling, or loss of strength in an arm or leg, A known bone abnormality in the upper neck. Google Scholar. However, like any surgical procedure, therapy, or treatment, spinal manipulation can have serious health risks if performed incorrectly or if administered by a chiropractic physician whos unfamiliar with non-rotational methods of manipulation. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK. Obtain Long Term Pain Relief. Past medical history was remarkable for hypertension, gastroesophageal reflux disease, obstructive sleep apnea, and right ulnar nerve entrapment. Twelve Ways that Chiropractic BioPhysics Can Improve Your Life. Am J Pub Health. Deep tendon reflexes (DTRs) were 1+ and symmetric with reinforcement at the patella and achilles bilaterally. Repeated end range loading was unremarkable for centralization or peripheralization. Spine. Be visible and accessible with your up to date contact 2019- c5/6 ACDF. If the cause is appropriate and responsive to conservative care then Chiropractic care with it's many therapeutic treatments is important and appropriate. DTRs were trace bilaterally and symmetric at the patella and achilles, strength was 5/5 and symmetric throughout the bilateral lower extremities, and sensation to light touch was intact bilaterally and symmetrically. Passive care and active rehabilitation in a patient with failed back surgery syndrome. Springer Nature. Some possible workarounds include turning more at the waist, modifying mirrors, and/or using a vehicle backup camera to avoid turning the neck too far. CBP providers have helped thousands of people throughout the world realign their spine back to health, and eliminate a source of chronic back pain, chronic neck pain, chronic headaches and migraines, fibromyalgia, and a wide range of other health conditions. All four patients denied adverse effects or onset of new symptoms after treatment. In regards to chronic low back pain, approximately 67.5% of patients receive spinal surgery [20, 21]. 2014;7:46570. Overall range of motion is minimally impacted Unless your surgeon specifies otherwise, the overall range of motion in your neck after ACDF is likely to be similar to what it was beforehand. https://doi.org/10.1186/s12998-017-0136-0, DOI: https://doi.org/10.1186/s12998-017-0136-0. Kumar K, North RB, Taylor RS, et al. However, these patients should not endure rotational-type treatments. Showers are typically allowed 2 or 3 days after surgery, but it is best not to point the shower head directly at the incision. Kho St Cng Trnh Ngm harry will funeral home. Leboeuf-Yde C, Hennius B, Rudberg E, Leufvenmark P, Thunman M. Side effects of chiropractic treatment: a prospective study. You may use theseHTMLtags and attributes: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); As an Amazon Associate, I earn from qualifying purchases. Spinal fusion surgery is when an orthopedic surgeon removes the disks between two or more spinal vertebrae and fuses the bones together with metal screws and plates. If youre considering an anterior cervical discectomy with fusion (ACDF) surgery for neck pain, its common to worry about how much your neck will be able to move after the procedure. Make a donation. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Available Solutions for Pain Relief from Mayo Clinic Store, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Can I see a chiropractor after having spinal fusion surgery? OShaughnessy J, Drolet M, Roy JF, Descarreaux M. Chiropractic management of patients postdisc arthroplasty: eight case reports. Is Minimally Invasive Spine Surgery Right for You? Maigne JY, Planchon CA. Patients should avoid any twisting and bending motions, or else they risk breaking the graft. 2005;30:15260. Lumbar spine range of motion was moderately limited in all directions, without a directional preference. Abnormal bone formation may inhibit the mobility of an artificial disk. Your email address will not be published. Cite this article. When searching for a chiropractor following your fusion, try looking for chiropractors in your area that utilize Activator adjusting tools or who practice "Upper. Ultimately, it depends on the case, and which part of the spine was fused and why. Article Following that period, he reported continued low back pain and right lower extremity dysesthesia and pain which was subsequently treated with spinal cord stimulator implantation in 2010. can you go to chiropractor after cervical fusion. 2002. Instead, he underwent a trial of care consisting of flexion distraction mobilization to the lumbar spine and myofascial release to the paralumbar musculature. This may seem strange, but it won't once you consider what happens when you get an adjustment. It is OK to let soap and water run on the incision so long as it is gently rinsed and patted dry. Protocol for permanent placement includes a preliminary trial of stimulation where a patient is expected to report pain relief of 50% or more [3]. A systematic review and meta-analysis performed by Taylor et. 2014;14(6):489505. Often, we may stay away from the exact area of the surgery, but we can positively affect the regions above and below. J Manipulative Physiol Ther. Sacroiliac joint pain after lumbar fusion. If this aching or soreness occurs, it is usually within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. You will still benefit from adjustments to your upper back and the rest of the spine as well as muscle work done on the neck region to release the tension in the area. let go let god tattoo vinny. Quack Watch: Tips on Choosing a Chiropractor. PubMed Central For a full description of this disclaimer, please see our Terms of Use. If your graft is adequately healed and your physician feels that you are strong enough to endure mild spinal manipulations, you can reach out to your Ideal Spine chiropractor to discuss Chiropractic BioPhysics (CBP) treatment options. Of the previously mentioned conditions, the current most common indicator for SCS is FBSS [13, 6, 7], which is defined as persistent lumbar and lower extremity pain after lumbar spine surgery [1, 4]. volume25, Articlenumber:5 (2017) Is chiropractic still an option, even after major spinal surgery? Opioids are only recommended for short-term use because of their risk for serious side effects, including addiction. Taylor RS, Buscher E, Van Buyten J-P. Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: A systematic review and analysis of prognostic factors. He presented to our clinic 4years post implantation with continued low back pain and right lower extremity pain that was provoked with walking more than mile, standing more than 10min, golfing, and lifting heavy objects. Spine J. Your Login details are incorrect. Strengthening the graft is crucial in maintaining the integrity of the bones and immobilizing the spine. Evidence-based guidelines for the chiropractic treatment of adults with headache. Please always consult your physician before taking any advice learned here or in any other educational medical material. Participate in Health Journeys in over 100 specialty communities. J Spinal Disord Tech. Tibialis anterior and dorsalis pedis pulses were intact, strong, and symmetric bilaterally, without evidence of edema or palpable tenderness. Article A 47-year-old man presented with a history of chronic Visit our Doctors Directory to get started. Google Scholar. AskMayoExpert. Whitmore has a Bachelor of Arts in English literature from the University of Cincinnati, fitness certifications and dietetics training from Cincinnati State Technical and Community College. Eur Spine J. Chiropractors treat muscles, muscle attachments, and joints. Chiropractic management of postoperative spine pain: a report of 3 cases. can you go to chiropractor after cervical fusion. 15(4):307-11. There is a major misconception that if you have had neck or back surgery, then you can no longer visit a chiropractor for care. Gluck NI. While rotational methods applied to the fused segments may be ill-advised, many chiropractic techniques can help people without the need to twist & pop the neck. Multiple well healed scars were present midline in the lumbar spine. Its still crazy to think there was a time where so many of us were Dr. Andrew Agasar is a third-generationchiropractor serving the Hatboro, Horsham, Warminster, Warrington, and Willow Grove communities. In spinal fusion surgery, an orthopedic surgeon removes the discs between two or more vertebrae and then fuses the bones together with screws. About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact However, chiropractic is very inherently safe. 1994;17(2):8892. The chiropractor also needs to perform a thorough examination to assess the proper treatment plan, but your spinal health doesnt end with just two vertebrae. Prior treatment had included acupuncture, physical therapy, and opiate and non-opiate analgesics which the patient found to be temporarily beneficial. Access from your area has been temporarily limited for security reasons. // Leaf Group Lifestyle. can you go to chiropractor after cervical fusion. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 4. 1. can you go to chiropractor after cervical fusion 07 Feb. can you go to chiropractor after cervical fusion. 1160 Taylor Street Suite 100 In an effort to minimize the opportunity for lead fracture, we limited physical contact to the patients spinal cord stimulator and took care to avoid excess torsional forces of the lumbar spine. Posted at 15:43h in ross barkley celebration by adlerian psychotherapy carlson. Ultimately, it depends on the case, and which part of the spine was fused and why. 2011;34(6):40812. When performed by licensed chiropractic physicians, chiropractic care can be incredibly beneficial in reducing different types of back, neck, or joint pain. Chiropr Man Therap 25, 5 (2017). RP performed the literature review and prepared the manuscript. Anterior Cervical Discectomy and Fusion Complications, Postoperative Care for Decompression/Fusion Surgery, Anterior Cervical Discectomy and Fusion (ACDF) Video. The reported percentage of patients with chronic low back pain who experience 50% pain relief or more post SCS ranges from 5062% [1, 8, 11], and reported patient satisfaction ranges from 7085% [8, 9]. Here are four reason you should see a chiropractor: Low back pain. J Manipulative Physiol Ther. Rachel M. Perrucci. Conversely, Deer et. At the time of the consultation, the patient denied bilateral lower extremity weakness, radiating pain, numbness, or tingling, bowel or bladder dysfunction, saddle anesthesia, fever, chills, nausea, vomiting, unexpected weight change, or abdominal complaints. Reversible side effects, such as progression of neurological deficits resulting from lumbar disc herniation are relatively uncommon, and irreversible complications are extremely rare; the risk of irreversible cauda equina syndrome is estimated to be associated with 1 in 100 million lumbar spine manipulations [15]. He denied bilateral lower extremity weakness, saddle anesthesia, bowel or bladder dysfunction, unexpected weight change, fever, chills, nausea, vomiting, abdominal complaints, or temporal factors. It might seem counterintuitive, but sometimes a single-level ACDF can result in an increase in the necks overall range of motion compared to pre-surgery measurements. Research has shown that chiropractic spinal manipulations can decrease migraine frequency, decrease pain, and reduce the need for migraine medication. A Tuohy needle is used to place percutaneous electrodes into the epidural space, while electrodes from paddle leads are placed surgically during a laminotomy or laminectomy [3]. Mild relief was achieved with NSAIDs, morphine, moist heat, and lying in a lateral decubitus position. Fax: 208-209-6009 pothead friendly jobs 0 sn phm / 0 . Cookies policy. Spine. Most of these surgical patients have suffered for years with pain after the surgery. 2012. al. 2014;17:57198. Adam Tanase, D.C., a St. Louis-area chiropractor, advises that while chiropractors should not use rotational methods, or twist-and-pop, that fusion patients could benefit from other spinal manipulation techniques. Morningstar MW, Strauchman MN. 2016;18:110. Further Reading: There is moderate evidence for clinical efficacy of spinal manipulation therapy for acute and chronic low back pain [1416], but the physiological mechanisms behind the effects of spinal manipulation are still unknown [14]; main theories include: release of entrapped synovial folds, relaxation of hypertonic muscles via sudden stretching, disruption of articular or periarticular adhesions, and hypoalgesia of the associated dorsal horn of the spinal segment manipulated [14]. Therapies also are helpful in these cases. Pain and energy levels tend to fluctuate after cervical artificial disc replacement surgery, especially during the first couple weeks. Depending on the patients health, it could take at least a year of combined convalescence and therapy to fully recover. Low back pain. The fusion can take anywhere from three months to a year to become solid after surgery, and you could still have some symptoms during that time. can you go to chiropractor after cervical fusionpalestine in the time of jesus powerpoint. Browse some of our other blog posts below. 3 Weeks to 3 Months After Cervical Artificial Disc Replacement Surgery. The patient resided with his wife, had a remote history of tobacco use (greater than 40years prior), and used alcohol socially. Deer TR, Mekhail N, Provenzano D, et al. Neuromodulation. Speech therapy can be helpful after surgery that affects your brain. In the United States, SCS is approved by the Food and Drug Administration for chronic trunk and limb pain, intractable low back pain, leg pain, and failed back surgery syndrome (FBSS) [3]. How this occurs is not known. 1999-2023 Veritas Health, LLC. At your initial visit, your chiropractor will ask questions about your health history and perform a physical exam, with particular attention to your spine. yuzu sake near singapore; marc jacobs headquarters new york; yreka union high school district. Find doctors & request online appointments. During a typical chiropractic adjustment, your chiropractor places you in specific positions to treat affected areas. DTRs were 2+ brisk bilaterally and symmetric at the patella, and 2+ bilaterally and symmetric at the achilles. The main objective of this study is to describe the potential adverse effects of lumbar spine manipulation in post-surgical patients with spinal cord stimulators; the cases presented were drawn from patients presenting at the VA Connecticut Healthcare System. One of the most helpful therapies used post-surgery is chiropractic care, which involves performing chiropractic adjustments to allow your body to heal and relieve pain and discomfort in the body. He reported experiencing no adverse reactions or onset of new symptoms post treatment. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. As there was no increase in his low back pain or provocation of lower extremity symptoms, he underwent a trial of treatment including HVLA spinal manipulation to the upper lumbar spine and lower thoracic spine, flexion-distraction mobilization to the lumbar spine, and myofascial release to the lumbar paraspinal muscles. Because chiropractic involves such intricate manipulations of the spine, many patients who have endured back or spinal fusion surgery are hesitant to consider seeking chiropractic treatment. CC and RP provided care for the patients. Click here. Written informed consent to publish has been obtained from all persons involved in this study.
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