Articles: back-pain.
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Back pain and related disability seem to be increasing among older adults. Health-related fitness tests have been developed to identify individuals at risk for mobility difficulties. However, poor fitness as a risk factor for back problems has seldom been studied. The purpose of the current study was to investigate whether performance in fitness tests predicts back pain and related disability during 6 years of follow-up. ⋯ Tests of balance, trunk flexibility and trunk muscle endurance, as well as BMI can be implemented as screening tools for identifying persons with increased risk of back pain and related disability.
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Clinical Trial
[Transforaminal lumbar interbody fusion for the treatment of degenerative spondylolisthesis].
Degenerative spondylolisthesis (DS) is a common cause of lumbal and lumbosacral pain as well as radicular pain. Retention and fusion is a good treatment option. Some patients have a symptomatic adjacent degenerative disc disease (DDD) in addition to DS. In these cases the adjacent segments should be fused as well. There are different techniques of fusion available, such as posterior with instrumentation or additional anterior support. This study evaluated results of transforaminal lumbar interbody fusion (TLIF) in patients with monosegmental DS and adjacent DDD. ⋯ The TLIF procedure is a safe and effective treatment for monosegmental DS with adjacent symptomatic DDD. Clinical results (pain, function) show no difference between both kinds of fusion (dorsal fusion and instrumentation versus dorsal fusion with instrumentation and TLIF) for the adjacent DDD. However, additional anterior support is more effective for relordosation of the segment. This could have impact on the mid-term and long-term outcome or in cases of adjacent segment fusion.
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Over the past decade, there has been a dramatic increase in the number of spinal fusions performed in the US and a corresponding increase in the incidence of adjacent-segment disease (ASD). Surgical management of symptomatic ASD consists of decompression of neural elements and extension of fusion. It has been shown to have favorable long-term outcomes, but the cost-effectiveness remains unclear. In this study, the authors set out to assess the cost-effectiveness of revision surgery in the treatment of ASD over a 2-year period. ⋯ In the authors' practice, revision decompression and extension of fusion provided a significant gain in health state utility for patients with symptomatic ASD, with a 2-year cost per QALY gained of $62,995. When indicated, revision surgery for ASD is a valuable treatment option for patients experiencing back and leg pain secondary to ASD. The findings provide a value measure of surgery that can be compared with future cost-per-QALY-gained studies of medical management or alternative surgical approaches.
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During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. ⋯ Simulating an increased lordosis for the pregnant situation in the sagittal plane substantially reduced these acting countertorques and therefore the demand on the segmental muscles. It is assumed that hyperlordosis is a physiological adaptation to the anatomical changes during pregnancy to minimize the segmental countertorques and therefore the demand on the segmental muscles. Further, it can be expected that an enhanced muscle activity caused by selective activity of lumbar muscles increases the stability of the lumbar spine and may improve the situation with LBP during pregnancy.
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Review Case Reports
Persistent hiccups after interventional pain procedures: a case series and review.
Interventional spine procedures are nonsurgical interventions that are commonly used to treat acute and chronic pain. These procedures generally are considered to be safe, but patients may experience transient and minor complications. ⋯ A comprehensive literature review of hiccups associated with interventional pain procedures is provided, along with the known pathophysiology, etiologies, and treatment options for hiccups. The objective of this case series presentation and literature review is to highlight the importance of recognizing hiccups as a potentially under-reported adverse reaction in the setting of various interventional spine procedures.