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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Lack of standardization of terminology in low back pain (LBP) research has significantly impeded progress in this area. The diversity in existing definitions for a 'recurrence of an episode of LBP' and 'recurrent LBP' is an important example. The variety of definitions used by researchers working in this area has prevented comparison of results between trials and made meta-analyses of this data unfeasible. ⋯ Four rounds were completed with responses rates of 94, 91, 83, and 97% in rounds 1, 2, 3, and 4, respectively. Consensus definitions were reached in both areas with 95% of panel members supporting the definition of a 'recurrence of an episode of LBP' and 92% of panel members supporting the definition of 'recurrent LBP'. Future research is necessary to evaluate these definitions.
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The effect of physical activity on neck and low back pain is still controversial. No systematic review has been conducted on the association between daily physical activity and neck and low back pain. The objective of this study was to evaluate the association between physical activity and the incidence/prevalence of neck and low back pain. ⋯ Of high-quality studies, there was limited evidence for no association between physical activity and neck pain in workers and strong evidence for no association in school children. Conflicting evidence was found for the association between physical activity and low back pain in both general population and school children. Literature with respect to the effect of physical activity on neck and low back pain was too heterogeneous and more research is needed before any final conclusion can be reached.
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Multicenter Study
Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases.
Surgical treatment of the cervico-thoracic junction (CTJ) in the spine require special evaluation due to the anatomical and biomechanical characteristics of this spinal section. The transitional zone between the mobile cervical and the relatively rigid thoracic spine can be the site of serious unstable traumas or neoplastic lesions. Frequently, injury is associated with neurological impairment due to the small caliber of the spinal canal and/or spinal cord vascular insufficiency. ⋯ There is no type of instrumentation more effective than other. In each single lesion, the most suitable type of instrumentation should be employed, considering morphology, biomechanics, and familiarity of the spinal surgeon with different implants and constructs. Therefore, we prefer to use posterior cervicothoracic fixation in T1 lesions with involvement of the vertebral body and subsequently replace the body with cage without anterior stabilization.
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Epidural steroid injections are an important therapeutic modality employed by spinal surgeons in the treatment of patients with chronic low back pain with or without lumbar radiculopathy. The caudal epidural is a commonly used and well-established technique; however, little is known about the segmental level of pathology that may be addressed by this intervention. This prospective study of over 50 patients aimed to examine the spreading pattern of this technique using epidurography. ⋯ Although in selected cases thoracic and high lumbar levels can be reached, this is variable. If pathology at levels above L3 needs to be addressed, we propose a 30° head tilt may improve cephalic drug delivery. The caudal route is best reserved for pathology below L3.
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This paper quantifies the relationship between early retirement due to back problems and wealth, and contributes to a more complete picture of the full costs associated with back problems. The output data set of the microsimulation model Health&WealthMOD was analysed. Health&WealthMOD was specifically designed to measure the economic impacts of ill health on Australian workers aged 45-64 years. ⋯ Of those who have retired early due to back problems who do have some wealth, on average the total value of this wealth is 87% less (95% CI: -90 to -84%) than the total value of wealth accumulated by those who have remained in full-time employment with no health condition controlling for age, sex and education. The financial burden placed on those retiring early due to back problems is likely to cause financial stress in the future, as not only have retired individuals lost an income stream from paid employment, but they also have little or no wealth to draw upon. Preventing early retirement due to back problems will increase the time individuals will have to amass savings to finance their retirement and to protect against financial shocks.