Spine
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A systematic review of randomized and quasi-randomized controlled trials. ⋯ There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low back pain. Conclusions are confounded by clinical heterogeneity among studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently.
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A systematic review. ⋯ The quality of the research on interreliability and intrareliability of spinal palpatory diagnostic procedures needs to be improved. Pain provocation tests are most reliable. Soft tissue paraspinal palpatory diagnostic tests are not reliable.
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Comparative Study
Value of magnetic resonance imaging and discography in determining the level of cervical discectomy and fusion.
The correlation between magnetic resonance imaging and discography of the cervical spine in degenerative disc disease was studied. In addition, the results of cervical discectomy and fusion were evaluated. ⋯ Magnetic resonance imaging can identify most of the painful discs but still has relatively high false-negative and false-positive rates. There is a high chance that hypointense signal and small herniated discs are the pain generators, but they are not always symptomatic. Discography can save the levels from being unnecessarily fused. The combination of clinical symptoms, magnetic resonance imaging, and discography provides the most information for decision making and can improve the management of cervical discogenic pain.
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Comparative Study
Relevance of aerobic capacity measurements in the treatment of chronic work-related spinal disorders.
Prospective cohort study of rehab program completers, comparing aerobic capacity data of chronic lumbar spinal disorder patients (CLSD) to that of chronic cervical spinal disorder (CCSD), collected from a tertiary care facility. ⋯ Although mean aerobic fitness levels for all patients improved during rehabilitation, the improvement is almost entirely accounted for by initially invalid tests becoming valid. Aerobic capacity testing measured with submaximal bicycle ergometry may frequently be invalid when fear-avoidance limits effort, particularly in CLSD. Psychosocial fear-avoidance, as it applies to bicycle ergometry, can be overcome in virtually all patients motivated to complete a tertiary rehabilitation program. As such, prerehabilitation aerobic capacity testing is a poor differentiator of postrehabilitation outcomes.