The spine journal : official journal of the North American Spine Society
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Case Reports
Intradural, extramedullary spinal sarcoidosis: report of a rare case and review of the literature.
Spinal sarcoidosis represents a rare subgroup of neurosarcoidosis. Most spinal sarcoid lesions are intramedullary, and only eight cases of intradural, extramedullary sarcoid lesions have been reported hitherto. We describe the complete entity of intradural, extramedullary spinal sarcoidosis. ⋯ An extramedullary sarcoid lesion is rare. Unlike intramedullary sarcoid lesions, it can be totally removed. Even if systemic sarcoidosis is present, the patient can have an excellent recovery. From a review of the literature, we can hypothesize that intradural extramedullary spinal sarcoidosis may represent a very early stage of spinal sarcoidosis progressing to intramedullary intradural spinal sarcoidosis. The intradural extramedullary spinal sarcoidosis can be subdivided into a peripheral and a central subtype. Positive histological examination is required to establish the diagnosis since other diagnostic tests are unspecific.
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Assessment of patients with complaints of low back or leg pain varies with the subspecialty of the treating physician. The evaluation of the spine patient may include magnetic resonance imaging (MRI), bone scan, or single-photon emission computed tomography (SPECT) imaging. The interpretation of these tests and the examiner's biases will impact the outcome of patient treatment and the cost to the health-care system. ⋯ MRI interpretation of the lumbar spine is comparable between specialties. Nuclear imaging studies (bone scan/SPECT) demonstrated a poorer correlation between examiners. The presence of MRI changes enables an accurate prediction of bone scan or SPECT scan findings. SPECT scan demonstrates an increased sensitivity in the detection of spinal abnormalities and the ability to localize a lesion when compared with planar bone scan.
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Randomized Controlled Trial Comparative Study
Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters.
Spinal manipulation is a widely accepted therapeutic approach in the treatment of back pain. In standard training programs, feedback on student performances is provided by an instructor based on teaching and clinical experience. Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature. ⋯ The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids. Such a device can provide specific feedback on specific parameters of the task during learning; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues.
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The Short Form 36 (SF-36) health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age- and gender-specific population norms. ⋯ All four lumbar spine disorders have a significant negative impact on all eight of the SF-36 scales. The greatest negative impact was seen in those scales that measure physical health (role limitations due to physical symptoms [RP], physical functioning [PF], and bodily pain [BP]). The HNP diagnostic group experienced a significantly greater impact upon these three scales. This diagnostic group had the youngest patients, whose baseline physical functional status would be expected to be the most optimal. When we stratified by age in all the diagnostic groups, the greatest negative impact scores for physical health were seen in the <40 years and 40-60 years age groups. These patients were also more likely to perceive their health as poor, experience decreased energy, and have more social impairment when compared with their age/gender norms.
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Randomized Controlled Trial
Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.
Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results. ⋯ Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.