The spine journal : official journal of the North American Spine Society
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Comparative Study Controlled Clinical Trial
Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis: posterior lumbar interbody fusion may be better than posterolateral fusion.
More and more orthopedic surgeons recognize the importance of the sagittal balance of the spine. ⋯ Either PLF or PLIF would lead a great change in spinopelvic parameters and deformity parameters. The decrease of PT may be an important role for the short-term surgical outcome. The PLIF could increase the LL and form a more reasonable sagittal alignment. From the point of the sagittal spinopelvic balance, the PLIF may be better than the PLF for patients with isthmic spondylolisthesis.
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There is growing concern that patient-reported outcomes (PROs) commonly used in clinical research evaluating treatments such as epidural steroid injections (ESIs) for lumbar spinal stenosis may not adequately capture outcomes of greatest importance to older adults. ⋯ Older adults with spinal stenosis rated problems related to pain and physical function as the most important outcomes to them. However, difficulty exercising and difficulty participating in hobbies and leisure activities were also among the most highly rated and were two areas not typically assessed in treatment studies. Commonly used PROs in spinal stenosis treatment studies may be insufficient to comprehensively assess outcomes from the patient perspective.
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Low back pain and disability are major public health problems and may be related to paraspinal muscle abnormalities, such as a reduction in muscle size and muscle fat content. ⋯ Paraspinal fat infiltration, but not muscle CSA, was associated with high-intensity pain/disability and structural abnormalities in the lumbar spine. Although cause and effect cannot be determined from this cross-sectional study, longitudinal data will help to determine whether disabling low back pain and structural abnormalities of the spine are a cause or result of fat replacement of paraspinal muscles.
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The phosphorylated neurofilament heavy subunit (pNfH) is an axon fiber structural protein that is released into the cerebrospinal fluid (CSF) after nerve damage. Although the previous studies have reported elevated CSF levels of pNfH in various neurological diseases, including amyotrophic lateral sclerosis, these levels have not been examined in patients with spinal stenosis. ⋯ This study detected elevated pNfH levels in the CSF of patients with LSS. Patients with severe clinical symptoms were more likely to exhibit high levels of pNfH. Our results indicate the potential usefulness of pNfH as a biomarker for compressive spinal disorders.
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Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. ⋯ A CDR was developed that may help primary care clinicians classify patients with strictly defined acute LBP into low-, moderate-, and high-risk groups for developing chronic pain and performed acceptably in 1,000 bootstrapped replications. Validation in a separate sample is needed.