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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In recent years, there has been much debate on the treatment of whiplash-associated disorders (WAD). It is not clear if the treatments commonly employed are effective, and concerns have been raised on the available scientific evidence of many of these treatments. The aim of this study was to review the literature systematically to analyze the evidence basis of many commonly used treatments for patients suffering from WAD, both in the acute and the chronic state. ⋯ Based on the degrees of evidence and the practical obstacles, the following treatments can be recommended: Early physical activity in acute WAD, radiofrequency neurotomy, combination of cognitive behavioral therapy with physical therapy interventions, and coordination exercise therapy in chronic WAD. High-quality RCTs are not common in the field of WAD. More research is needed, particularly on the treatment of chronic WAD.
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Purely extradural cavernous hemangiomas of the spinal canal are extremely rare. Their occurrence at the lumbosacral level is a true exception. ⋯ Cavernous hemangioma should be considered in the differential diagnosis of an enhancing extradural periradicular mass causing chronic lumbar radiculopathy especially in fertile women. Lumbar extradural hemangiomas appear and behave differently, not only from intramedullary cavernous hemangiomas but also from extradural hemangiomas of other spinal locations.
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The aim of this study was to define the influence of whiplash injuries on the perceived condition of health 3 years after injury. We evaluated remaining symptoms and the use of health services. Insurance companies provided reports and medical certificates from traffic accidents in Finland in 1998, for those injured who had agreed to take part in the study. ⋯ Although some of the injured had improved in the long term, some reported that their health condition was worse after 3 years than at the 1-year follow-up. The percentage of respondents reporting a significant health deterioration remains unchanged 3 years after the whiplash injury. These findings illuminate the importance of early recognition of risk factors for long-term disability and the primary treatment and rehabilitation procedures.
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The purpose of this study was to assess the outcome of peri-radicular infiltration for radicular pain in patients with spinal stenosis and lumbar disc herniation (LDH). Patients with spinal stenosis ( n=62) or LDH ( n=55) who met our criteria received fluoroscopically guided peri-radicular infiltration of local anaesthetic and steroid at the site of documented pathology. All the patients were followed-up at 3 months. ⋯ There was a significantly better response to peri-radicular infiltration for radicular pain in patients with LDH than the spinal stenosis. Our findings help us to provide a better information for future patients. We do not know if this is a treatment effect or natural history of the pathology, as this is a cohort study and not a randomised controlled trial.