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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The aim of the study was to evaluate validity, reliability, responsiveness and practicality of the NASS-AAOS (North American Spine Society--American Academy of Orthopaedic Surgeons) questionnaire in patients with low back pain. ⋯ The instrument is valid, sensitive to clinical changes and reliable for comparisons between groups, but further study is needed for its application in monitoring individual patients.
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The rat L5/6 facet joint, from which low-back pain can originate, is multisegmentally innervated from the L1 to L5 dorsal root ganglions (DRGs). Sensory fibers from the L1 and L2 DRGs are reported to non-segmentally innervate the paravertebral sympathetic trunks, whilst those from the L3 to L5 DRGs segmentally innervate the L5/6 facet joint. In the current study, characteristics of sensory DRG neurons innervating the L5/6 facet joint were investigated in rats, using a retrograde neurotransport method, lectin affinity- and immuno-histochemistry. ⋯ Under physiological conditions in rats, DRG neurons transmit several types of sensations, such as proprioception or nociception of the facet joint. Most neurons transmitting pain are CGRP-IR peptide-containing neurons. They may have a more significant role in pain sensation in the facets via peptidergic DRG neurons.
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Clinical Trial
Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients.
The treatment of neurologically intact patients with thoracolumbar burst fractures is still controversial. This study was designed to evaluate the role of nonoperative treatment for 29 neurologically intact patients with two- or three-column-injured thoracolumbar burst fractures. Neurologically intact patients with types A, B and C burst fractures were treated conservatively and divided into groups GI and GII, according to their column involvement, with two and three injured columns, respectively. ⋯ None of the patients had neurological deterioration. Most of the functional results were satisfactory. As a result, it was concluded that nonoperative treatment could be an alternative method for neurologically intact two- and three-column-injured Denis-types A, B and C thoracolumbar burst fractures.
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Clinical Trial
Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results.
The unilateral transforaminal approach for lumbar interbody fusion as an alternative to the anterior (ALIF) and traditional posterior lumbar interbody fusion (PLIF) combined with pedicle screw instrumentation is gaining in popularity. At present, a prospective study using a standardized tool for outcome measurement after the transforaminal lumber interbody fusion (TLIF) with a follow-up of at least 3 years is not available in the current literature, although there have been reports on specific complications and cost efficiency. Therefore, a study of TLIF was undertaken. ⋯ At the latest follow-up, significant differences of the ODI were neither found between isthmic spondylolistheses and degenerative diseases, nor between one- and multiple-level fusions. In conclusion, the TLIF technique has comparable results to other interbody fusions, such as the PLIF and ALIF techniques. The potential advantages of the TLIF technique include avoidance of the anterior approach and reduction of the approach related posterior trauma to the spinal canal.
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Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral disc sites with an obvious enhanced region in the posterior annulus of the disc on enhanced T1-weighted MR images was selected for intradiscal injection. ⋯ Gadolinium-DTPA enhanced T1-weighted MR images showed an obvious enhanced region in the posterior annulus of the intervertebral disc in 19 patients (48%). As for the clinical characteristics of discogenic acute nonspecific low-back pain, the relatively young adult patients had no tenderness in the paravertebral muscles, and showed moderately degenerated intervertebral discs. The pathogenesis of discogenic acute nonspecific low-back pain is mostly considered to be a re-rupture in an asymptomatic ruptured region in the posterior annulus, repaired by granulation tissue, in a moderately degenerated intervertebral disc with a radial tear.