The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
Is a videotape to change beliefs and behaviors superior to a standard videotape in acute low back pain? A randomized controlled trial.
Cognitive behavioral therapy has been used successfully in acute low back pain (LBP) treatment, but the use of a cognitive behavioral videotape as an adjunct to treatment has not been studied. ⋯ Compared with a standard instructional videotape, a behavioral videotape did not change beliefs, outcomes, or costs over 1 year. Cost-effective behavioral interventions with high patient retention rates are needed, especially for those at greatest risk of high utilization of resources.
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The impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method. ⋯ The minimum detectable change (MDC) appears as a statistically and clinically appropriate MCID value. MCID values in this sample were 12.8 points for ODI, 4.9 points for PCS, 1.2 points for back pain, and 1.6 points for leg pain.
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Comparative Study
Biomechanical comparison of different anchors (foundations) for the pediatric dual growing rod technique.
Children with early onset scoliosis benefit from early operative treatment with dual growing rods as they provide an "internal brace" for the spine and allow curve correction and sequential lengthenings to maximize thoracic cage development. The foundations that provide anchor points for the dual growing rods may incorporate hooks, screws, or a hybrid construct. It is unclear how stable different types of foundation constructs are with regard to pullout. ⋯ A foundation composed of four pedicle screws implanted in two adjacent vertebral bodies provides the strongest construct in pullout testing. A cross-link does not seem to enhance fixation. Hook constructs are stronger in lumbar versus thoracic laminae.
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With lumbar arthroplasty gaining popularity, limited data are available highlighting changes in adjacent-level mechanics after multilevel procedures. ⋯ Our results indicate no significant adjacent-level biomechanical changes between arthroplasty and control groups. In contrast, significant alterations in ROM and IDP were recorded both proximally (ROM=LB & AR; IDP=AR, FE, LB) and distally (ROM=LB; IDP=AR & LB) after circumferential arthrodesis. Therefore, two-level lumbar arthroplasty maintains a more favorable biomechanical environment at the adjacent segments compared with the conventional transpedicular fixation technique. This, in turn, may have a positive effect on the rate of the transition syndrome postoperatively.
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Seven previous systematic reviews (SRs) have evaluated back schools, and one has evaluated brief education, with the latest SR including studies until November 2004. The effectiveness of fear-avoidance training has not been assessed. ⋯ Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting. The discordance between reviews can be attributed differences in inclusion criteria and application of evidence rules.