The spine journal : official journal of the North American Spine Society
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Epidural corticosteroid injections are commonly used to treat back and leg pain associated with lumbar spinal stenosis. However, little is known about which patient characteristics may predict favorable responses. ⋯ Among 21 baseline patient characteristics examined, none, including clinician-rated spinal stenosis severity, were consistent predictors of benefit from epidural injections of lidocaine+corticosteroid versus lidocaine only.
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Only Level 3 evidence exists for the diagnosis and treatment of atlantooccipital dislocation (AOD) with few studies examining mortality, neurologic improvement, and patient-reported outcomes (PROs). ⋯ Our work suggests that failure to diagnose AOD is a powerful predictor of mortality. Higher ISS scores and better neurologic presentation were significantly associated with missed diagnosis. Craniocervical arthrodesis preserved neurologic function with low complication rate and unexpectedly high PROs and return-to-work. These results must be carefully interpreted because it is unclear whether missed AOD diagnosis accompanies another death-causing injury (eg, traumatic brain injury) or if failure to treat AOD contributes to mortality in a multifactorial manner.
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Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. ⋯ The WDQ includes two factors and has strong construct validity in individuals with acute WAD. Our results demonstrate that the WDQ is valid for use as an overall summative scale or as the daily activities and emotional subscales in clinical and research settings to determine disability status.
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The clinical importance of lumbar pathology identified on magnetic resonance imaging (MRI) remains unclear. It is plausible that pathology seen on MRI is a risk factor for a recurrence of low back pain (LBP); however, to our knowledge, this has not been investigated by previous studies. ⋯ We identified promising risk factors for a recurrence of LBP, which should be further investigated in larger trials. The findings suggest that pathology seen on MRI plays a potentially important role in recurrence of LBP.