Spine
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Economic evaluation provides a framework to explicitly measure and compare the value of alternative medical interventions in terms of their clinical, health-related quality-of-life, and economic outcomes. Computerized economic models can help inform the design of future prospective studies by identifying the cost-drivers, the most uncertain parameter estimates, and the parameters with the greatest impact on the results and inferences. ⋯ Future research should focus on quantifying the health-related quality-of-life impact of bone morphogenetic protein relative to autogenous iliac crest bone graft, as well as the impact on lost productivity.
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Individuals with low back pain were classified by cluster analysis of their responses to the Dallas Pain Questionnaire. These results enabled development of an alternative simple classification tool that yielded results close to those obtained by the cluster analysis. ⋯ The Dallas Pain Questionnaire discriminated between different groups of persons with low back pain. The proposed classification uses a short, simple practical tool to assess different levels of low back pain.
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A 7-year prospective cohort study of 34,754 employed men and women was conducted. ⋯ In a broad public health perspective within a European welfare system, subjects at high risk for future back pain disability pension perceived their work as constantly physically demanding, had health complaints other than back pain, and mostly felt generally tired and worn out. The results indicate that interventions directed toward the painful back alone may be unsuccessful in preventing disability pensions.
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The lumbar sacropelvis in 11 patients with myelomeningocele and kyphosis was treated with a subtraction kyphectomy technique and posterior instrumentation. The results of this procedure in the 11 patients were evaluated and compared with previous results. ⋯ The subtraction (decancellation) vertebrectomy technique with preservation of the dural sac is a safe and efficacious technique for correction and stabilization of myelomeningocele kyphosis in young patients. Morbidity is reduced, as compared with that of excision techniques. Restoration of sagittal alignment at the time of initial correction and stabilization to achieve a balanced spine led to acceptable results.
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Case Reports
Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm: report of two cases.
Two cases of lumbar vertebral erosion resulting from abdominal aortic false aneurysm are reported. ⋯ In patients with endovascular prostheses, false aneurysm should be considered when lytic lesions of vertebral bodies are differentially diagnosed because these patients can present with only spinal symptoms.