The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises.
Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. ⋯ Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up.
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Comparative Study Clinical Trial
Provocative lumbar discography versus functional anesthetic discography: a comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain.
There is mounting evidence that the currently available techniques for the diagnosis of discogenic low back pain are insufficiently accurate-this may explain some of the variability in outcomes of surgery for this important clinical problem. New diagnostic methods are needed to address this diagnostic issue; improvements here may do as much to improve overall patient outcomes as improvements in surgical treatment methods. ⋯ We have presented the results of a new diagnostic technique in 52 patients with chronic low back pain presumed discogenic in origin that was designed to help differentiate between symptomatic and asymptomatic disc degeneration. The findings of the test differed from those of standard pressure-controlled PD in 46% of the cases reported on here. Further studies are needed to demonstrate the clinical utility of the test.
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Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. We describe a severe complication associated with this procedure; only one previous case has been reported in the literature. ⋯ Although percutaneous vertebroplasty has many benefits, including its simplicity and relative safety, it could lead to serious complications. The current case demonstrates the direct leakage of cement within the anterior spinal artery leading to an irreversible paralysis. The clinicians should be aware of such complications to happen and explain it to their patients.
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Vertebral compression fractures (VCFs) are a substantial health concern. Kyphoplasty (KP) and vertebroplasty (VP) are vertebral augmentation procedures (VAPs) used to treat VCFs. ⋯ Vertebral augmentation procedures have seen a continued increase in use from 2004 to 2008. Use of KP significantly outpaces the use of VP. Reasons for the increasing utilization of KP likely include financial incentives, the specialty performing KP, perceived safety, and effectiveness of vertebral height restoration. Conflicting evidence regarding which procedure is safer warrants further evaluation.
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Laminectomy for lumbar stenosis-associated radiculopathy is associated with improvement in pain, disability, and quality of life. However, given rising health-care costs, attention has been turned to question the cost-effectiveness of lumbar decompressive procedures. The cost-effectiveness of multilevel hemilaminectomy for radiculopathy remains unclear. ⋯ Multilevel hemilaminectomy improved pain, disability, and quality of life in patients with lumbar stenosis-associated radiculopathy. Total cost per QALY gained for multilevel hemilaminectomy was $33,700 when evaluated 2 years after surgery with Medicare fees, suggesting that multilevel hemilaminectomy is a cost-effective treatment of lumbar radiculopathy.