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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To evaluate the surgical outcome in terms of functional and subjective recovery, patients who needed discectomies at L1-L2, L2-L3 and L3-L4 levels were compared with an age and sex-matched group of patients who required L4-L5 and L5-S1 discectomies. We prospectively enrolled 50 consecutive patients, referred to our center, who had L1-L2, L2-L3 and L3-L4 herniations and required surgical intervention. Likewise, a comparative group of 50 consecutive patients with herniations at L4-L5 and L5-S1 were selected. ⋯ Surprisingly, as many as 25% of the former had even an increase in ODI scores after surgery. Gender was also a conspicuous factor in determining the surgical outcome of patients with upper lumbar disc herniation, and male patients had more reduction in ODI score than female patients (P = 0.007). Since the functional recovery in patients with herniated lumbar disc, especially upper lumbar herniation, is influenced by preoperative ODI scores, the use of ODI or any other standard pain assessment tool is a sensible consideration as an inherent investigative method to preclude unfavorable surgical outcome.
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Several prospective studies examining patients receiving physical therapy support the predictive validity of FABQ subscale scores. This has lead to the proposition that the FABQ would be a useful screening tool, permitting early identification of patients at risk for a poor outcome with an opportunity to modify the treatment accordingly. However, the predictive validity of the FABQ within physical therapy practice has yet to be examined. ⋯ Only the FABQ-W subscale was predictive of poor outcome and this was only identified in the worker's compensation group. The results suggest that the work subscale of the FABQ might be an appropriate screening tool to identify patients with work-related LBP who are at risk for a poor outcome with routine physical therapy. Neither FABQ subscale was predictive of outcome for patients with private insurance, and the use of the FABQ, as a screening tool for patients with non-work-related LBP was not supported.
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The object of this study is to review the early clinical results and radiographic outcomes following insertion of the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN), together with its effect on maintaining sagittal alignment of the functional spinal unit (FSU) and overall sagittal balance of the cervical spine for the treatment of single-level or two-level symptomatic disc disease. Forty-seven patients with symptomatic single or two-level cervical disc disease who received the Bryan Cervical Artificial Disc were reviewed prospectively. A total of 55 Bryan disc were placed in 47 patients. ⋯ Clinical results are encouraging, with significant improvement seen in the Bryan Cervical Artificial disc. The Bryan disc preserves motion of the FSU. Although the preoperative lordosis (or kyphosis) of the FSU could not always be maintained during the follow-up period, the overall sagittal balance of the cervical spine was usually preserved.
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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. ⋯ Further failure-analysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.
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Comparative Study
Pain intensity and severe pain in young immigrant patients with long-standing back pain.
The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27-45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. ⋯ Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95-4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.