The spine journal : official journal of the North American Spine Society
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Review
Causal assessment of occupational carrying and low back pain: results of a systematic review.
Occupational low back pain (LBP) is a common musculoskeletal disorder that results in high healthcare use and a heavy societal burden from morbidity and medical costs. The etiology of LBP is unclear, although numerous physical activities in the workplace have been implicated in its development. Determining the causal relationship between LBP and specific occupational activities requires a rigorous methodological approach. ⋯ This review failed to identify high-quality studies that supported any of the Bradford-Hill criteria to establish causality between occupational carrying and LBP. Based on these results, it is unlikely that occupational carrying is independently causative of LBP in the populations of workers studied.
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Low back pain (LBP) is a common musculoskeletal disorder associated with a considerable social and economic burden within the working-age population. Despite an unclear etiology, numerous physical activities are suspected of leading to LBP. Declaring a causal relationship between occupational activities and LBP remains challenging and requires a methodologically rigorous approach. ⋯ The studies reviewed did not support a causal association between workplace manual handling or assisting patients and LBP in a Bradford-Hill framework. Conflicting evidence in specific subcategories of assisting patients was identified, suggesting that tasks such as assisting patients with ambulation may possibly contribute to LBP. It appears unlikely that workplace manual handling or assisting patients is independently causative of LBP in the populations of workers studied.
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Discectomy is a common procedure for treating sciatica. However, both the operation and preceding herniated disc alter the biomechanical properties of the spinal segment. The disc mechanics are also altered in patients with chronic contained herniation. The biomechanical properties of the disc can potentially be restored with an elastomeric nucleus replacement implanted via minimally invasive surgery. ⋯ This study demonstrates that despite having different material properties, a nucleus replacement implant can restore the axial compressive mechanical properties of a disc after a discectomy. The implant carries compressive load and transfers the load into annular hoop stress.
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Vertebral osteolysis has been reported as a complication of off-label recombinant human bone morphogenetic protein-2 (rhBMP-2) use in transforaminal lumbar interbody fusion (TLIF). It has been postulated that end plate violation during disc space preparation, rhBMP-2 overdosing, or a combination thereof can contribute to the development of vertebral osteolysis when rhBMP-2 is used in the lumbar interspace. ⋯ It has been proposed that rhBMP-2-induced vertebral osteolysis occurring in TLIF procedures may be secondary to end plate violation during disc preparation or overdosing of rhBMP-2. Although overdosing may have also contributed to vertebral osteolysis in our two cases, the end plate violation from subchondral cyst formation that was present on preoperative CT scans seemed to be the origin of the osteolysis suggesting that the presence of preoperative subchondral cysts may be an additional risk factor for development of osteolysis in these patients.
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The correlation between obesity and incidence of complications in spine surgery is unclear, with some reports suggesting linear relationships between body mass index (BMI) and complication incidence and others noting no relationship. ⋯ This prospective assessment of perioperative complications in elective degenerative thoracolumbar procedures shows no relationship between patient BMI and the incidence of perioperative minor or major complications. Specific care in perioperative positioning may limit the risk of perioperative positioning palsies in obese patients.