Spine
-
Multicenter Study Clinical Trial Controlled Clinical Trial
Tuberculous lesions of the lumbosacral region. A 15-year follow-up of patients treated by ambulant chemotherapy.
A 15-year clinical follow-up of tuberculous lesions of the lumbosacral region. ⋯ In tuberculosis of the lumbosacral region, the development of kyphosis is minimal in patients older than 17 years, when growth has already stopped, and deformity is expressed more as foreshortening of the trunk. Children younger than 10 years old have more severe involvement with increased tendency toward greater kyphosis. They are also prone to progressive deformity through the years when the anterior growth plates are destroyed. Surgery is indicated in this group to prevent greater deformity.
-
Comparative Study
The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain.
A retrospective case-control comparison between the Soft Tissue Stablization System according to Graf and instrumented posterolateral fusion in a consecutive series of patients operated on by a single surgeon. ⋯ Outcome after Soft Tissue Stabilization was associated with a worse outcome at 1 year and a significantly higher revision rate at 2 years. Revision was associated with a poor outcome similar to that seen in revision after fusion.
-
In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed. ⋯ Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.
-
A case-control study using magnetic resonance imaging and plain radiography to evaluate whether a family history of lumbar disc herniation is a risk factor for disc degeneration. ⋯ The current study provided evidence that a family history of operated lumbar disc herniation has a significant implication in lumbar degenerative disc disease. There may be a genetic factor in the development of lumbar disc herniation as an expression of disc degeneration.
-
One shortcoming of clinical practice guidelines is that generic, one-for-all guideline recommendations do not account for differences among patients' views about the desirability (or undesirability) of specific health outcomes, such as low back pain. Because differences in patients' preferences may lead to differences in the preferred therapy, a clinical practice guideline that does not consider patients' preferences may provide recommendations that are not optimal. Recently developed methodologic approaches enable guideline developers to assess the role of patients' preferences in clinical decisions and guideline recommendations, and to develop preference-based guidelines. ⋯ These options range from informal discussions with patients to computer-based utility assessments. Patients' preferences are an important factor in clinical decisions regarding management of low-back pain, particularly in decisions about surgical management and symptom control. Although further research is needed to define the role of techniques for assessing patients' preferences in routine clinical practice, guideline developers can determine when patients' preferences should play a prominent role in guideline recommendations.