Spine
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Review Case Reports
Acute progression of spondylolysis to isthmic spondylolisthesis in an adult.
Acute progression of spondylolysis to spondylolisthesis in an adult without degenerative disc disease at the slip level is reported. ⋯ This case is important because it illustrates the potential for acute progression of spondylolisthesis with minimal trauma. A patient with known spondylolysis who sustains acute severe exacerbation of his or her back pain should have repeat standing radiographs.
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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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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial.
A randomized controlled comparative trial with an 8-month follow-up period was conducted. ⋯ The McKenzie method and intensive dynamic strengthening training seem to be equally effective in the treatment of patients with subacute or chronic low back pain.