Articles: low-back-pain.
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The presence of lumbar facet joint pain has been overwhelmingly supported and the accuracy of controlled diagnostic blocks has been demonstrated in multiple studies and confirmed in systematic reviews. However, controversy surrounds the following related issues: placebo control, the amount of relief (50% versus 80%), single block versus double block, and placebo or comparative control. ⋯ Controlled diagnostic lumbar facet joint nerve blocks are valid utilizing the criteria of 80% pain relief and the ability to perform previously painful movements, with a sustained diagnosis of lumbar facet joint pain in at least 89.5% of the patients at the end of a 2-year follow-up. In contrast, the diagnosis was sustained in 51% of the patients with 50% relief at the end of 2 years. Thus, inappropriate diagnostic criteria will increase the prevalence of facet joint pain substantially, leading to inappropriate and unnecessary treatment.
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Degenerative disc disease (DDD) is a major health problem worldwide. Both Modic lesions and Schmorl's nodes are considered to correlate with DDD such as low back pain. Modic lesions are the changes of degenerative vertebral endplate and adjacent bone marrow observed on magnetic resonance imaging and are divided into three types. Modic type III lesions are thought to represent extensive subchondral bone sclerosis within the bone marrow of adjacent endplate. The pathological performance of Schmorl's nodes is cystic lesions around indistinct sclerotic margins and beneath the cartilaginous endplate. Coincidently, there are many similarities between Modic type III lesions and Schmorl's nodes including pathological appearances, pathogenetic location and related diseases. ⋯ This hypothesis explains the possible pathologic process of Modic type III lesions and Schmorl's nodes. If the hypothesis were conformed, Modic type III lesions and Schmorl's nodes will be rediscovered, which provides the new basis for the clinical treatment of DDD. In additions, this hypothesis also has crucial significances for the classification of Modic lesions.
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Although the role of radiographic abnormalities in the etiology of nonspecific low back pain (LBP) is unclear, the frequent identification of these features on radiologic studies continues to influence medical decision making. ⋯ Degenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP.
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J Manipulative Physiol Ther · Mar 2010
Mechanical vs manual manipulation for low back pain: an observational cohort study.
This is an observational prospective cohort study to explore the treatment effect of mechanical vs manual manipulation for acute low back pain. ⋯ This study highlights the challenges inherent with conducting research that allows for "treatment as usual." The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol.
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To determine whether low back pain (LBP) associates with altered postural stabilization and concomitant changes in cerebrocortical motor physiology. ⋯ These results support a theoretical model that altered central motor neurophysiology associates with LBP, thereby implying that rehabilitation strategies should address these neuromotor impairments.