Spine
-
Back pain is an important problem for primary care physicians; it is common, costly, and controversial. Back pain is the second leading symptom prompting all physician visits in the United States. There are wide geographic variations in medical care for this problem, and surgical rates in the United States are twice those of most developed countries. ⋯ Second is to develop a better theory to explain the large majority of episodes of nonspecific low back pain. At present, competing theories generate competing and conflicting treatments, generating frustration among patients and loss of credibility for clinicians. Third, we need better science, with greater methodologic rigor in the evaluation of the many nonsurgical treatments used for back pain in the primary care setting.
-
Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. ⋯ Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.
-
Multicenter Study Clinical Trial
Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain.
This prospective, multicenter study was designed to investigate the efficacy and outcome of spinal cord stimulation using a variety of clinical and psychosocial outcome measures. Data were collected before implantation and at regular intervals after implantation. This report focuses on 70 patients who had undergone 1 year of follow-up treatment at the time of data analysis. ⋯ This prospective, multicenter study confirms that spinal cord stimulation can be an effective therapy for management of chronic low back and extremity pain. Significant improvements in many aspects of the pain condition were measured, and complications were minimal.
-
Comparative Study
The prolapsed intervertebral disc. The high-intensity zone with discography correlation.
The study compared the presence of the high-intensity zone on magnetic resonance imaging with the results of awake discography. ⋯ Although the high-intensity zone is present within the posterior anulus of some abnormal discs, it is not necessarily associated with a concordant pain response.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Efficacy of autotransfusion in spine surgery: comparison of autotransfusion alone and with hemodilution and apheresis.
Two prospective groups of patients received intraoperative autologous transfusion during reconstructive spine surgery. Before intraoperative autologous transfusion, one group underwent normovolemic hemodilution and apheresis of blood components in the operating room while being prepared for surgery. The allogeneic blood products needed for transfusion by each group were studied and compared with those of a retrospective group of patients receiving conventional transfusion therapy. ⋯ A combination of hemodilution and apheresis and intraoperative autologous transfusion significantly decreased transfusion of allogeneic blood products and reliance on preoperative autologous deposit. Autologous transfusion of all blood products was significantly increased.