The spine journal : official journal of the North American Spine Society
-
Randomized Controlled Trial Clinical Trial
A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain.
Intradiscal electrothermal therapy (IDET) is a treatment for discogenic low back pain the efficacy of which has not been rigorously tested. ⋯ Nonspecific factors associated with the procedure account for a proportion of the apparent efficacy of IDET, but its efficacy cannot be attributed wholly to a placebo effect. The results of this trial cannot be generalized to patients who do not fit the strict inclusion criteria of this study, but IDET appears to provide worthwhile relief in a small proportion of strictly defined patients undergoing this treatment for intractable low back pain.
-
Diastematomyelia is uncommon and rarely presents in adulthood. This report draws attention to the fact that patients who underwent spinal fusion for deformity before the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) may have unrecognized spinal cord abnormalities. This should be considered if revision surgery is contemplated. ⋯ Progressive weakness without any previous neurologic deficit or neurocutaneous stigmas of an underlying spinal cord abnormality may develop in the adult with unrecognized diastemotomyelia. This case demonstrates that a thorough preoperative workup of patients with complex spinal deformities is imperative.
-
Few empirical data are available that document changes in population-based rates for the evaluation and treatment of nonspecific back pain. ⋯ The national pattern of health care for nonspecific low back pain observed in the present study serves as a basis for future investigations into the management of this major public health problem. Findings suggest that perhaps a duplication of care is partly responsible for the high degree of health care utilization in this population.
-
In preclinical and clinical joint replacement applications, porous tantalum has been shown to be osteoconductive and effective for biological fixation. Relatively little research has been undertaken to investigate the porous tantalum implants for potential application in intervertebral spinal fusion. ⋯ In this porcine ALIF model, the radiographic and histological appearances of the porous tantalum ring were equivalent to those of the carbon fiber cage. The high presence of radiolucencies and fibrous tissue layer at the vertebrae-implant interface suggests that an initial stabilizing biomechanical environment is important in order to achieve bone ingrowth in the interbody fusion devices in this ALIF model.
-
Discectomy is a surgical technique commonly used to treat bulging or herniated discs causing nerve root compression. Clinical data suggest discectomy may also help patients with contained discs and no clear neural compromise. However, the mechanisms of clinical efficacy are uncertain, and consequently bases for treatment optimization are limited. ⋯ Our results demonstrate that percutaneous plasma discectomy alters the expression of inflammatory cytokines in degenerated discs, leading to a decrease in IL-1 and an increase in IL-8. Whereas both IL-1 and IL-8 have hyperalgesic properties, IL-1 is likely to be a more important pathophysiologic factor in painful disc disorders than IL-8. Therefore, the alteration in cytokine expression that we observed is consistent with this effect as a mechanism of pain relief after discectomy. In addition, given that IL-1 is catabolic in injured tissue and IL-8 is anabolic, our results suggest that a percutaneous plasma discectomy may be capable of initiating a repair response in the disc.