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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Low-back pain is a major health and socio economic problem. Functional restoration programs (FRP) have been developed to promote the socio-professional reintegration of patients with important work absenteeism. The aim of this study was to determine the long-term effectiveness of FRP in a group of 105 chronic low-back pain patients and to determine the predictive factors of return to work. ⋯ Three predictive factors were found: younger age at the onset of low-back pain, practice of sports, and shorter duration of sick leave at baseline. FRP show positive results in terms of return to work for chronic LBP patients with prolonged work absenteeism. Efforts should be made to propose such programs at an earlier stage of the disease.
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For patients whose scoliosis progresses, surgery remains the ultimate way to correct and stabilise the deformity while maintaining as many mobile spinal segments as possible. In thoracolumbar/lumbar adolescent idiopathic scoliosis (AIS), the spinal fusion has to be extended to the lumbar spine. The use of anterior spinal fusion (ASF) instead of the classic posterior fusion (PSF) may preserve more distal spinal levels in attempt to limit the consequences of surgery on trunk mobility. ⋯ Notably, the EMG timing activity did not change. The total muscular mechanical work (W (tot)) increased by 6% mainly due to the external work (W (ext)), i.e. the work performed by the body muscles to move the body in its surroundings. The energy cost, although showing a tendency towards a reduction, remained globally excessive, probably due to the excessive co-contraction of the lumbo-pelvic muscles.
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Case Reports
Incarcerated herniation of the cervical spinal cord after laminectomy for an ossification of the yellow ligament.
A 74-year-old man showed a spastic gait and myelopathy in both the hands. Computed tomography revealed an OPLL on C3 and C4, bony spurs on the dorsal side of C4-C6, and an OYL on C3 and C4. We scheduled a two-stage decompression for both the OPLL and OYL. ⋯ The patient's myelopathy gradually improved. There have been no reports on postoperative neurological deterioration caused by spinal cord herniation associated with a dural defect at the laminectomy site, without dural tear in the surgery after the resection of a posteriorly located cervical OYL. The possibility of a dural defect in OYL cases should be considered when planning a laminectomy for the resection of the OYL.
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Serious vascular injury is a rare, but potentially devastating complication during anterior lumbar spinal surgery. The authors describe the first reported case where vascular injury was detected by multimodality neurophysiological monitoring during an L3-S1 anterior lumbar interbody fusion. The case demonstrates the need for multi-modality monitoring and the combined use of somatosensory-evoked potentials and motor-evoked potentials.
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Delayed post-traumatic osteonecrosis, also known by its eponym Kummell's disease, is a rarely reported clinical entity that likely occurs with higher frequency than recognized. We highlight a case of a 75-year-old female household ambulator who presented with significant thoracolumbar pain and delayed T12 collapse after a ground-level fall. The patient had sustained a trivial fall at home 4 months prior to this presentation and had been hospitalized in our institution at that time for a general medical workup. ⋯ Her final radiograph after her surgery demonstrated that the T12 vertebroplasty had maintained its height and sagittal alignment. This Grand Round case highlights the clinical presentation of Kummell's disease. Aspects of the clinical entity that will be discussed include a historical review of the disease, hallmark radiographic findings and treatment options.