Spine
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Review Comparative Study
The cochrane review of advice to stay active as a single treatment for low back pain and sciatica.
A systematic review was conducted within the Cochrane Collaboration Back Review Group. ⋯ The best available evidence suggests that advice to stay active alone has little beneficial effect for patients with acute, simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.
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Eight patients with a herniated disc after lumbar spinal fusion are reported. Their clinical features, imaging studies, and management are reported. ⋯ Herniated disc after lumbar spinal fusion was found in approximately 1.3% of patients. Although rare, this entity that should be considered when patients complain of recurring back pain after a lumbar spinal fusion.
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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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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.