The spine journal : official journal of the North American Spine Society
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Comparative Study
Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results.
Kyphoplasty, a minimally invasive technique for fracture reduction and stabilization, has been shown to reduce pain and restore vertebral body height in patients with vertebral compression fractures (VCFs). Analyses comparing treatment outcomes of acute versus chronic VCFs have not yet been reported. ⋯ Fracture reduction was best achieved in acute fractures. Symptomatic chronic fractures may also remain candidates for kyphoplasty because pain relief and improvement in patient function are reliable and some kyphosis correction can still be achieved in many of these patients.
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The past three decades have witnessed increasing interest in strategies to improve neurologic function after spinal cord injury. As progress is made in our understanding of the pathophysiologic events that occur after acute spinal cord injury, neuroprotective agents are being developed. ⋯ This review summarizes some of the important pathophysiologic processes involved in secondary damage after spinal cord injury and discusses a number of pharmacologic therapies that have either been studied or have future potential for this devastating injury.
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Comparative Study
Can a patient educational book change behavior and reduce pain in chronic low back pain patients?
This study was prompted by 1) the almost universal use of patient education as an initial or at least an ancillary step in the treatment of patients presenting with low back pain, 2) the relative dearth of studies evaluating the effectiveness of patient education and 3) the complete lack of support in the few existing studies for the efficacy of education in improving patients' long-term health status. ⋯ This study's results suggest that the Treat Your Own Back book may have considerable efficacy in helping readers decrease their own low back pain and reduce the frequency of, or even eliminate, their recurrent episodes. These findings also justify conducting a randomized controlled clinical trial to assess this book's efficacy in improving health status in subjects with low back pain with the study design including internal controls to minimize bias issues and a wider range of outcomes, including measures of pain, function, disability, patient satisfaction, utilization of health care services and psychosocial measures.
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Obtaining adequate purchase with standard pedicle screw techniques remains a challenge in poor quality bone. The development of alternate insertion techniques and screw designs was prompted by recognition of potential fixation complications. An expandable pedicle screw design has been shown to significantly improve fixation compared to a conventional screw in poor quality bone. ⋯ PMMA cement augmentation of the expandable pedicle screw may be a viable clinical option for achieving fixation in severely osteoporotic bone.
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Optimal treatment of nonmalignant chronic spinal disorders (CSDs) may require the use of one or more nonopioid psychotropic medications. Vast research literature has documented high rates of psychiatric disorders in patients with CSDs. Psychotropic medications are one type of effective treatment for these disorders. Many medications of this type are also used as adjuvants to primary analgesic medications. ⋯ Psychotropic medications are extremely useful in the treatment of psychiatric disorders comorbid with CSDs and modestly useful as analgesic adjuvants, particularly with pain of neuropathic etiology. Familiarity with these medications will aid the primary treating physician in optimizing outcomes in this difficult group of patients.