Articles: back-pain.
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Hyaluronidase is an enzyme additive used in local anaesthesia and interventional pain reducing procedures such as adhesiolysis of epidural scar tissue after spinal surgery. Only a limited number of studies describe the influence of drugs on hyaluronidase activity. Postulated effects and effectiveness of hyaluronidase are only based on clinical observations. ⋯ Hyaluronidase is effective in all combinations with drugs. To get the maximum effect calculated use of accompanying drugs is necessary.
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Arthritis and rheumatism · Nov 2008
Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years.
Magnetic resonance imaging (MRI) is increasingly used to detect sacroiliitis earlier. This study was undertaken to investigate what proportion of patients with MRI-evident sacroiliitis develop ankylosing spondylitis (AS) in the long term and whether there are predictors of outcome. ⋯ Our findings indicate that in patients with early IBP, a combination of severe sacroiliitis and HLA-B27 positivity has a high specificity for development of AS, compared with mild or no sacroiliitis, regardless of HLA-B27 status, which confers a low likelihood of developing AS. This has implications for the diagnosis of "early" AS and possibly for selection of more aggressive therapies.
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Multicenter Study Clinical Trial
Defining patient-centered, multidimensional success criteria for treatment of chronic spine pain.
This study aimed to define patient-determined success criteria for treatment of chronic spine pain across four domains: pain, fatigue, emotional distress, and interference with daily activities. ⋯ Future research should validate these success criteria, particularly for the less studied domains of fatigue, distress, and interference, and investigate how these criteria evolve over the course of different treatments.
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The pathophysiology of intervertebral disc degeneration has been extensively studied. Various factors have been suggested as influencing its aetiology, including mechanical factors, such as compressive loading, shear stress and vibration, as well as ageing, genetic, systemic and toxic factors, which can lead to degeneration of the disc through biochemical reactions. How are these factors linked? What is their individual importance? There is no clear evidence indicating whether ageing in the presence of repetitive injury or repetitive injury in the absence of ageing plays a greater role in the degenerative process. ⋯ Degradation of the molecular structure of the disc during ageing renders it more susceptible to superimposed mechanical injuries. This review supports the theory that degeneration of the disc has a complex multifactorial aetiology. Which factors initiate the events in the degenerative cascade is a question that remains unanswered, but most evidence points to an age-related process influenced primarily by mechanical and genetic factors.