Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Feb 2006
ReviewFailed back surgery syndrome: surgical and nonsurgical approaches.
Failed Back Surgery Syndrome is a common and challenging clinical problem. Often the anatomic pain source is unclear. Relevant outcome studies are rarely diagnosis specific, and high level research studies comparing surgical and nonsurgical approaches to Failed Back Surgery Syndrome studies have not been published to date. Surgical strategies focus on decompressing neural impingement or fusing unstable or putatively painful intervertebral discs. Nonsurgical interventions range from nerve root specific blocks for pain relief to multidisciplinary rehabilitation programs geared toward improving function. This paper reviews the most common interventions and concludes with recommendations for the care of the individual patient. ⋯ Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.
-
Clin. Orthop. Relat. Res. · Feb 2006
Comparative StudySecond application of low-energy shock waves has a cumulative effect on free nerve endings.
Some physicians recommend treating tendinopathies with multiple sessions of shock waves. Some evidence, however, suggests shock wave application can induce nerve fiber degeneration. We questioned whether repeated shock wave application provides a cumulative effect on nerve fibers compared with the effect of one application. ⋯ Reinnervation occurred slower in the repeated-treatment group. These data show that a second application has a cumulative effect on nerve fibers. Our data suggest multiple applications of low-energy shock waves might a provide longer-lasting antinociceptive effect.