Spine
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Using a retrograde neurotracing method with Fluoro-Gold (FG), the level at which dorsal root ganglions (DRGs) innervate the L2 and L5 vertebral bodies and the innervation pathways were investigated in rats. ⋯ Sensory nerve fibers in the L2 and L5 vertebral bodies are derived from the T11-L3 and T13-L6 DRGs, respectively. Some sensory nerves from the L2 and L5 vertebral bodies enter the paravertebral sympathetic trunks and reach the DRGs at multisegmental levels. The present findings regarding multisegmental innervation to vertebral bodies may explain the diffuse pain that originates within osteoporotic vertebral fractures in elderly patients.
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Randomized Controlled Trial Comparative Study
Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation.
Pragmatic, randomized, assessor blinded, clinical trial with economic analysis. ⋯ For chronic low back pain, all three physiotherapy regimens improved disability and other relevant health outcomes, regardless of their content. Physiotherapist-led pain management classes offer a cost-effective alternative to usual outpatient physiotherapy and are associated with less healthcare use. A more widespread adoption of physiotherapist-led pain management could result in considerable cost savings for healthcare providers.
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Prospective case-control study testing a new diagnostic method. ⋯ The study demonstrates that it is feasible and safe to measure NO with a real time-sensor in or around the facet joints. The findings of higher concentrations of NO in the perifacetal region in chronic low back patients compared with healthy controls indicate that the degenerative process of the joints in these patients may cause increased NO production. The observation of higher NO concentrations in the perifacetal region in patients responding to corticosteroid/local anesthetic infiltration indirectly suggest a more pronounced inflammatory process in these patients.
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A retrospective assessment of 12 patients with pyogenic spondylitis accompanied by iliopsoas abscess treated by continuous irrigation with our new method between March 2003 and July 2005. ⋯ This treatment is minimally invasive and useful in carefully selected patients with pyogenic spondylitis complicated by iliopsoas abscess.
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Retrospective radiographic/imaging study. ⋯ There is a close linear association between the facet fluid index and the amount of radiographic instability at L4-L5. Facet fluid on MRI should raise high suspicion of lumbar instability.