European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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A 67-year-old patient suffered a fall and sustained injuries to the thorax, combined with fractures of the ribs, sternum and thoracic spine. Her pre-existing kyphosis (caused by osteoporotic vertebral collapse) increased in severity. There was a clear relationship between a sternal fracture, deterioration of thoracic kyphosis and a fracture of the thoracic spine.
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The authors report on the first known application in the spine of percutaneous ablation of osteoid osteoma using radio-frequency waves. The technique involves a CT-guided biopsy of the lesion followed by introduction of a 1-mm probe connected to a radio-frequency lesion generator. ⋯ The technique++ described may become the procedure of choice in the surgical treatment of osteoid osteoma, as it minimises surgical trauma and post-operative pain. Longer follow-ups are required to monitor the incidence of recurrence.
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Randomized Controlled Trial Clinical Trial
Conservative treatment in patients sick-listed for acute low-back pain: a prospective randomised study with 12 months' follow-up.
We evaluated three different conservative treatment methods for acute low-back pain patients in groups following a manual therapy programme, an intensive training programme, or a general practitioner programme, the latter serving as the control group. Patients aged 19-64 years on sick leave for low-back pain with or without sciatica were included in a prospective randomised study evaluating outcomes such as impairment, pain, functional disability, socio-economic disability and satisfaction with the treatment or explanations. Evaluation by unbiased observers was performed at 1, 3 and 12 months. ⋯ All three study groups showed rapid improvement. After 1 month a significant improvement was noted in all outcome values compared with the values on entry to the study. Within the limitations discussed in our study, it is concluded that (1) patients sick listed with acute low-back pain, with or without sciatica, will be significantly improved after 1 month regardless of conservative treatment programme; (2) they will be more satisfied with the treatment if they are referred to a manual treatment programme or a training treatment programme; (3) they will be more satisfied with the explanations of the acute low-back problem if they are referred to one of the above groups, especially the manual treatment group; (4) they will not show any other differences with respect to subjective and objective variables, either at short-term or at long-term follow-ups.
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A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. ⋯ Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.