Articles: back-pain.
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Vertebral hemangiomas are benign tumors with a rich vasculature. Symptoms may vary from simple vertebral pain, sometimes resistant to conservative medical treatment, to progressive neurological deficit. Surgery or radiotherapy have been the treatment of choice for several years, but they were worsened by intraoperative and postoperative hemorrhagic complications related to the rich vascularization that characterize these kinds of lesions, often preceded by a preoperative embolization in the acute setting. Recently, a percutaneous, minimally invasive technique of vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatment of symptomatic vertebral hemangiomas with or without features of aggressiveness at imaging studies. ⋯ PVP is an effective technique to treat symptomatic vertebral hemangioma, which is a valuable, minimally invasive, and quick method that allows a complete and lasting resolution of painful vertebral symptoms.
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Spinal surgical outcome studies rely on patient-reported outcome (PRO) measurements to assess treatment effect. A shortcoming of these questionnaires is that the extent of improvement in their numerical scores lack a direct clinical meaning. As a result, the concept of minimum clinical important difference (MCID) has been used to measure the critical threshold needed to achieve clinically relevant treatment effectiveness. As utilization of spinal fusion has increased over the past decade, so has the incidence of adjacent-segment degeneration following index lumbar fusion, which commonly requires revision laminectomy and extension of fusion. The MCID remains uninvestigated for any PROs in the setting of revision lumbar surgery for adjacent-segment disease (ASD). ⋯ Adjacent-segment disease revision surgery-specific MCID is highly variable based on calculation technique. The MDC approach with HTI anchor appears to be most appropriate for calculation of MCID after revision lumbar fusion for ASD because it provided a threshold above the 95% CI of the unimproved cohort (greater than the measurement error), was closest to the mean change score reported by improved and satisfied patients, and was not significantly affected by choice of anchor. Based on this method, MCID following ASD revision lumbar surgery is 3.8 points for BP-VAS score, 2.4 points for LP-VAS score, 6.8 points for ODI, 8.8 points for SF-12 PCS, 9.3 points for SF-12 MCS, and 0.35 quality-adjusted life-years for EQ-5D.
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Bmc Health Serv Res · Jan 2012
Consumers' experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours.
Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. ⋯ Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.
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⋯ Where there is no evidence of frank spondylolisthesis or displacement and pain does not radiate below the knee, we recommend direct repair of the pars interarticularis fracture, especially in young active adults. We describe a modified form of the Buck screw procedure with a minimally invasive, image-guided method of pars interarticularis fixation. The use of image guidance simplifies the otherwise difficult visualization required for pars interarticularis screw placement and allows minimal skin and muscle dissection, which may translate into a more rapid postoperative recovery.
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Eur J Cardiothorac Surg · Dec 2011
Risk factors for chronic thoracic pain after cardiac surgery via sternotomy.
This study examines the influence of patient demographics and peri- and postoperative (<7 days) characteristics on the incidence of chronic thoracic pain 1 year after cardiac surgery. The impact of chronic thoracic pain on daily life is also documented. ⋯ We have identified a number of factors correlated with persistent thoracic pain following cardiac surgery with sternotomy. Awareness of these predictors may be useful for further research concerning both the prevention and treatment of chronic thoracic pain, thereby potentially ameliorating the postoperative quality of life of a significant proportion of patients. Meanwhile, chronic thoracic pain should be discussed preoperatively with patients at risk so that they are truly informed about possible consequences of the surgery.