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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Randomized Controlled Trial
Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up.
A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation. ⋯ Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.
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Randomized Controlled Trial
Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?
To determine the frequency of different patterns of centralization and their association with outcomes and MRI findings in patients experiencing sciatica. ⋯ In patients with sciatica, centralization was common and associated with improvement in activity limitation and leg pain. Centralization was very common in ruptured disc therefore the study does not support the theory, that centralization only occurs if the intra-discal hydrostatic mechanism is functional.
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The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy. ⋯ The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.
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Multicenter Study
Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity.
Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). ⋯ Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater pre-operative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.