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 variables identified as predictors of surgical outcome often differ depending on the specific outcome variable chosen to designate "success". A short set of multidimensional core outcome measures was recently developed, in which each of the following domains was addressed with a single question and then combined in an index: pain, function, symptom-specific well-being, general well-being (quality of life), disability (work and social). The present study examined the factors that predicted surgical outcome as measured using the multidimensional core measures. 163 spinal surgery patients (mixed indications) completed questionnaires before and 6 months after surgery enquiring about demographics, medical/clinical history, fear-avoidance beliefs (FABQ), depression (Zung self-rated depression), and the core measures domains. ⋯ The inverse pattern was shown for the psychosocial predictors, which accounted for in each case approximately 20% variance in "function", "general well-being" and "disability" but only 12-14% variance in "pain" and "symptom-specific well-being". Further to previous studies establishing the sensitivity to change of the core-set, we have shown that a large proportion of the variance in its scores after surgery could be predicted by "well-known" medical and psychosocial predictor variables. This substantiates the recommendation for its further use in registry systems, quality management projects, and clinical trials.
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In Sweden, musculoskeletal disorders, in particular low back disorders (LBD) and neck-shoulder disorders (NSD) constitute by far the most common disorders, causing sick leave and early retirement. Studies that compare sickness absence in individuals with LBD and individuals with NSD are lacking. Moreover, it is likely that having concurrent complaints from the low back region and the neck-shoulder region could influence sickness absence. ⋯ In the present study, having concurrent LBD and NSD were associated with a higher risk for sickness absence and also long-term sickness absence. This suggests that, when research on sickness absence and return to work after a period of LBD or NSD is performed, it is important to take into consideration any concurrent pain from the other spinal region. The study also implies that spinal co-morbidity is an important factor to be considered by clinicians and occupational health providers in planning treatment, or in prevention of these disorders.
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A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. ⋯ Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.
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To help decide the best starting point for lumbar spine pedicle screw insertion in the Chinese population using three different techniques (Roy-Camille, Magerl, and Du). Three-dimensional CT reconstructions were created from 40 adult lumbar vertebral segments. Three different starting points for lumbar pedicle screw insertion were used. ⋯ These results demonstrate that Du's method provides the safest starting point to place pedicle screws from L1 to L4, as its distance from the entrance point to the pedicle axis is the shortest and the safe range of TSA the largest of the three techniques. Magerl's technique can be safely used in the pedicles from L3 to L5, and is the safest choice at L5. Roy-Camille's technique is most applicable at L1 and L2, but has the highest risk when applied from L3 to L5.