The spine journal : official journal of the North American Spine Society
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Outcomes of spinal treatments are evaluated by clinical relevance: the proportion of patients who reach a minimum clinically important outcome change. Outcomes are evaluated through multiple measurements, and the inconsistency of outcome change across measurements is not known. ⋯ Efforts should be made to take into account the inconsistency of outcomes and to make clinical relevance more readily understandable by patients and clinicians.
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Image-guided cervical nerve injections are being performed with increasing frequency. Severe complications are being reported. ⋯ A technique for cervical nerve injection is described with the results of the injection. This technique may allow some standardization in the procedure, decrease the learning curve for training physicians, and minimize the potential complications.
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Controlled Clinical Trial
Cytokine evaluation in individuals with low back pain using discographic lavage.
The pathophysiology underlying degenerative disc disease and its implication in painful syndromes remain unclear. However, spine magnetic resonance imaging (MRI) can demonstrate changes in disc water content and the annulus; provocative discography purportedly identifies degenerate discs causing serious low back pain; and biochemical assays have identified local inflammatory markers. No study to date has correlated pain on disc injection during discography evaluation with relevant MRI findings and biochemical markers. ⋯ Among the potential inflammatory markers tested in this Phase 1 study, IFN-gamma immunoreactivity was most commonly elevated in discogram "positive" discs but absent in asymptomatic controls. However, this marker was also frequently elevated in degenerative but "negative" discography discs. From these findings, Phase 2 and Phase 3 validity studies are reasonable to pursue. Phase 4 utility studies may be performed concurrently to assess this method's predictive value in outcome studies.
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Low back pain (LBP) is a widespread musculoskeletal condition that frequently occurs in the working-age population. Numerous occupational physical activities have been implicated in its etiology. ⋯ A summary of existing studies was not able to find any high-quality studies that satisfied more than two of the Bradford-Hill causation criteria for occupational standing or walking and LBP. Based on the evidence reviewed, it is unlikely that occupational standing or walking is independently causative of LBP in the populations of workers studied.
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High-speed computed tomography (CT) exams have replaced traditional radiographs for assessment of cervical spine injuries in many emergency departments. Recent evidence demonstrates that even subtle displacements can indicate significant upper cervical spine injuries. Many different anatomical measurements have been described in the upper cervical spine to date, most of them based on X-ray. The range of anatomical relationships that exist in an uninjured population must be known to reliably detect abnormal relations. The measurements with the lowest normal variation are likely to be most useful in detecting injuries. ⋯ These results revealed consistently narrow joint spaces and left-right symmetry in the upper cervical spine joints that do not vary according to demographics. There was distinctly greater consistency in the coronal plane, which enabled more precise diagnostic measurement and side-to-side comparison of measurements. This precision will enable more accurate identification of abnormal scans, which should prompt consideration for additional workup. Thus, better understanding of these relationships may enable earlier detection of subtle craniocervical dissociative injuries based on CT scan data. This is important, because the only evidence of a severe injury on CT can be subtle misalignment.