Revue du rhumatisme (Ed. française : 1993)
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A step-by-step account is given of how corticosteroids were found to be beneficial in rheumatoid arthritis. Current hypotheses concerning the mechanism of action of corticosteroid therapy are reviewed.
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Review
[Treatment of chronic lumbago and radicular pain by spinal cord stimulation. Long-term results].
Seventy-seven patients with chronic, refractory, low back and radicular pain underwent implantation of a spinal cord stimulator between 1984 and 1992. Most patients had failed back surgery syndrome. In every case, an epidural quadripolar "Resume" electrode was implanted surgically. ⋯ Adverse events included one case of meningitis, two cases of local infection, and one case each of cerebrospinal fluid fistula and necrosis of the skin overlying the stimulator. The main causes of treatment failure were complications, inappropriate patient selection, and the escape phenomenon. The results of this study demonstrate that spinal cord stimulation is effective for the treatment of chronic low back and radicular pain in carefully selected patients; scrupulous application of restrictive selection criteria is essential to the success of the method.
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The prevalence of neurological complications in patients with osteoporotic vertebral collapse and the risk factors for neurological compromise were studied retrospectively in 138 inpatients. Six per cent of patients had objective neurological loss. ⋯ Diagnosis was based on magnetic resonance imaging and examination of vertebral biopsy specimens. Comparison of patients with and without neurological loss suggested that an intravertebral vacuum phenomenon and/or a cortical osteoporosis may cause fracture of the posterior wall and therefore compression of neurological structures.
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The facet syndrome seems to be a common cause of low back pain. Percutaneous radiofrequency lumbar facet denervation, developed by Shealy, may be of therapeutic value in facet syndrome patients. This method consists in thermocoagulation of the middle branch of the dorsal primary ramus of the spinal nerve. ⋯ Success rates reported in the literature vary widely, from 14% to 76%. Interpretation of these data is difficult since studies used a broad range of treatment techniques, evaluation methods, and patient selection criteria. A prospective study using stringent inclusion criteria and appropriate evaluation criteria taking quality of life into account is needed to determine the role of percutaneous facet denervation among other treatment options available to low back pain patients.
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Facet syndrome is an apparently common although not readily identifiable cause of low back pain. To evaluate the efficacy of corticosteroid facet joint injection for the treatment of low back pain, we retrospectively studied 206 patients with low back pain ascribed to facet syndrome. Effectiveness was evaluated on the basis of a clinical score and of a questionnaire completed 10 to 34 months after treatment. ⋯ These broad ranges denote substantial variations in evaluation criteria and patient selection. Only two placebo-controlled trials have been performed. There is a need for a prospective study with strict inclusion criteria and appropriate evaluation criteria taking quality of life into account to determine the role of facet joint injection in low back pain.