The spine journal : official journal of the North American Spine Society
-
Multicenter Study Comparative Study Clinical Trial
Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life.
Multidisciplinary biopsychosocial rehabilitation has been shown in controlled studies to improve pain and function in patients with chronic back pain. However, specialized back pain rehabilitation centers are rare and only a few patients can participate on this therapy. Implementation of multidisciplinary rehabilitation services in community medicine may enhance both early availability and treatment capacity for comprehensive back pain rehabilitation. ⋯ MRP is promising to improve health-related quality of life for patients with chronic back pain in the community. Before implementation of MRP in the repertoire of community medicine, superiority of MRP over usual care should be confirmed by a randomized controlled trial.
-
Degenerative changes in the lumbar spine may result in a loss of spinal stability and subluxation of one vertebra relative to another. Cadaveric studies and clinical case series have suggested that listhesis may be much more common in African Americans than in whites. ⋯ The prevalence of anterolisthesis among older African American women living in the community was two to three times greater than that found in white women of a similar age. This condition was not related to an increased frequency of back problems nor did it adversely affect general physical function. Retrolisthesis was relatively rare but was associated with decreased back function.
-
Lumbar zygapophysial joints are currently believed to be a cause of axial low back pain. Once this diagnosis is made, decisions about when to institute a particular intervention and which treatment to offer is regionally and specialty dependent. ⋯ Current studies fail to give more than sparse evidence to support the use of interventional techniques in the treatment of lumbar zygapophysial joint-mediated low back pain. This review emphasizes the need for larger, prospective, randomized controlled trials with uniform inclusion and exclusion criteria, standardized treatment, uniform outcome measures and an adequate duration of follow-up period so that definitive recommendations for the treatment of lumbar zygapophysial joint-mediated pain can be made.
-
Comparative Study
Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome.
Anterior lumbar interbody fusion (ALIF) procedures have a known incidence of subsidence. The individual risk of subsidence for specific lumbar levels in ALIF procedures has not been determined. ⋯ There is a statistically significant increased incidence of subsidence at the L4-L5 level as opposed to other fused lumbar levels in ALIF fusions with BAK cage constructs. There is an increased incidence of subsidence with the PP constructs. Subsidence also is associated with increased reaming depth and with larger cage sizes. The lowest risk for subsidence was with single-level dual-standard cage constructs.
-
Postsurgical epidural adhesions and fibrosis after surgery for lumbar disc herniation are a consequence of normal wound healing. The presence of fibrosis renders reoperations risky, and in some patients fibrosis may lead to nerve root tethering. ⋯ Gels of CMC/PEO reduced epidural fibrosis and did not impair normal heal ing.