Spine
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A cross-sectional analysis of data derived from patients with chronic spinal pain undergoing evaluation at a multidisciplinary pain treatment center was conducted. ⋯ These findings indicate that both opioid use and gender are significant predictors of clinical status of patients with chronic spinal pain. More interesting, these two variables interact because opioid use was associated with increased affective distress among the men, but the reverse was true for the women. In addition, the women reported greater pain severity, which is consistent with some previous findings. Potential explanations for these findings are presented, and the practical implications are discussed.
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A retrospective data analysis of all trauma patients admitted the Helicopter Emergency Medical Service was performed. ⋯ Most of the patients had poor initial Functional Independence Measure scores, but there was significant improvement by 12 months. Discharge FIM scores were a good indicator for functional outcome at one year.
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Secondary analysis of a previously described cohort of prospective, consecutive patients with acute neck or low back pain referred to outpatient rehabilitation was performed. ⋯ Multiple-visit classification of patients into specific pain pattern subgroups is recommended when pain intensity and disability outcomes are of interest.
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Initial assessment involved 360 patients (90% women and 10% men) attending spinal and internal medicine clinics over a 6-year period who had experienced low back pain that had no obvious cause for more than 6 months. The patients ranged in age from 15 to 52 years. ⋯ Vitamin D deficiency is a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic. Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting. Measurement of serum 25-OH cholecalciferol is sensitive and specific for detection of vitamin D deficiency, and hence for presumed osteomalacia in patients with chronic low back pain.
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Pelvic morphology and lumbopelvic lordosis were measured on standing radiographs of 75 patients with greater than 10% L5-S1 spondylolytic spondylolisthesis. The findings were compared with those of 75 volunteers to determine significant differences between the two groups. ⋯ The pelvic and lumbopelvic parameters studied were different in patients compared with controls. The contribution of the pelvis to lordosis was significantly smaller in the subgroups of patients with increasingly larger grades of spondylolisthesis. Pelvic morphology may play a role in the development of spondylolisthesis. Measurement of the combined lumbar and pelvic (lumbopelvic) lordosis on standing radiographs is important.