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
-
Review
Is there a rational basis for post-surgical lifting restrictions? 2. Possible scientific approach.
Lifting restrictions postoperatively are quite common but there appears to be little scientific basis for them. Lifting restricitions are inhibitory in terms of return to work and may be a factor in chronicity. The mean changes in functional spinal motion unit (FSU) stiffness with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. ⋯ The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accomodations such as lifting aids. Such resitrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition.
-
Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. ⋯ At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.
-
Clinical Trial Controlled Clinical Trial
Sitting and low back pain: the positive effect of rotary dynamic stimuli during prolonged sitting.
In this study the effect of dynamic stimuli on low back pain during prolonged sitting was investigated. The pain experience of two groups of 60 subjects with a specific low back pain was recorded. ⋯ Two different frequencies of rotation were applied in subgroups. The authors concluded that such stimuli, especially of the lower frequency, reduced pain in prolonged sitting.
-
The purpose of this combined study was to evaluate the stability and safety of a new monocortical screw-plate system for anterior cervical fusion and plating (ACFP) according to Caspar in comparison with classical bicortical fixation. In the biomechanical part of the study two groups, each comprising six fresh human cadaveric spines (C4-C7), matched for bone mineral density, additionally resulting in almost the same mean age, were used. Range of motion and neutral zone were analyzed in flexion-extension, rotation (left, right) and lateral bending (left, right) using pure moments of +/- 2.5 Nm for each specimen in the intact state, after discectomy at C5/6 and after discectomy at C 5/6 followed by bone grafting plus plating (Caspar plates), with either monocortical or bicortical screws. ⋯ Following these findings monocortical screw fixation can be recommended for the majority of anterior cervical fusion and plating procedures in degenerative disease, making the procedure quicker, easier, and safer. Bicortical screw fixation still has specific indications for multilevel stabilization, poor bone quality (osteoporosis, rheumatoid disease - as bicortical oversized rescue screw), unstable spines (trauma, tumour) and in particular for the realignment of kyphotic deformities (restoration of the normal lordotic curve). Due to the design of the study the results apply only to surgical treatment of monosegmental degenerative disc disease at the time.
-
The Modular Type SB Charite disc prosthesis has been developed as a device for artificial disc replacement (ADR) in patients with symptomatic discopathies. Here, we report on our first series of 50 (out of 350) patients, who had a satisfactory clinical result in 70% of cases (2 years' follow-up). Subgroup analysis revealed that patients with an isolated discopathy without previous spinal operations or other pathology at the same or other spinal level benefitted more from the surgery. ⋯ We conclude that in patients with severe isolated symptomatic discopathies that are resistant to conservative treatment, a mobile disc prosthesis is worth considering as a real alternative to a spondylodesis. However, accurate patient selection is imperative. With these criteria we were encouraged by our results to continue the implantation of this artificial disc.