Articles: back-pain.
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Semin Musculoskelet Radiol · Apr 2011
ReviewPercutaneous vertebral augmentation: the status of vertebroplasty and current controversies.
Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past.
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There are several assumptions within clinical practice about who is more or less likely to consult a health care practitioner for particular symptoms, most commonly these focus around socio-demographic characteristics. We aimed to assess the evidence for the impact of socio-demographic characteristics on consultation for back pain. ⋯ The results from this review suggest that there is little evidence to support the common wisdom that socio-demographic characteristics impact on help-seeking in the context of back pain. As these assumptions relating to who is more or less likely to consult will ultimately affect patient care, it is important that they do not go unchallenged.
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Emergency radiology · Apr 2011
Case ReportsImaging findings in spinal subarachnoid hemorrhage in patient with hemophilia A: an unusual cause for back pain.
Back pain and presentation with spinal canal hemorrhage in hemophilia is not common; however, these are significant clinical issues and may lead to significant neurological issues and morbidity. We present an interesting case of severe back pain in a young patient with moderate hemophilia A. Imaging confirmed subarachnoid hemorrhage in the spinal canal without intracranial hemorrhage. ⋯ We also describe the anatomy and imaging features of hemorrhage in the different spinal canal compartments, including the subarachnoid space. Spinal canal hemorrhage in hemophilia is an emergency and serious condition and must be diagnosed and treated promptly. It is important to be aware of the diagnostic features of the spinal canal hemorrhage and carefully assess the spinal canal in hemophiliacs on cross-sectional studies.
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The variables pain intensity (SI), disability (DS) and quality of life (QoL) belong to a set of primary patient-based outcomes in chronic low back pain (CLBP). The avoidance-endurance model (AEM) assumes three maladaptive and one adaptive pain response pattern. The purpose of this study was to study the level and course of the outcomes with regard to the four AEM patterns. ⋯ The results show differences in the level and process of SI, DS and QoL between the subgroups. An AEM-based classification of subgroups is also reasonable for CLPB patients.
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Spinal cord stimulation is the most commonly used implantable neurostimulation modality for management of pain syndromes. For treatment of lower extremity pain, the spinal cord stimulator lead is typically placed in the thoracic epidural space, at the T10-T12 levels. Typically, satisfactory stimulation can be obtained relatively easily. Anatomical variability in the epidural space, such as epidural scarring, has been reported to prevent successful implantation of spinal cord stimulators. Spinal epidural lipomatosis describes an abnormal overgrowth of adipose tissue in the extradural space. Cases have documented spinal epidural lipomatosis complicating intrathecal baclofen pump implantation or causing repeated failure of epidural analgesia. However, so far, there is no published literature describing how spinal epidural lipomatosis affects spinal cord stimulation. ⋯ Spinal epidural lipomatosis significantly increases the impedance in the epidural space, making effective neurostimulation very difficult to obtain. Physicians should consider the possibility of spinal epidural lipomatosis when very high impedances are encountered during lead placement.