Articles: low-back-pain.
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Discogenic low back pain resulting from internal disc disruption can be severely disabling, clinically challenging, and expensive to treat. Previously, when conservative care had been exhausted, open surgical intervention such as spinal fusion or artificial disc replacement was the only treatment option for these patients. Intradiscal electrothermal therapy (IDET), a minimally-invasive technique performed in the outpatient setting, offers an intermediate intervention between conservative care and surgery. ⋯ Final indications for use consist of clinical and imaging criteria. There are 5 compulsory indications for use: 1) persistent axial low back pain +/- leg pain and non-responsive to > or = 6 weeks of conservative care; 2) history consistent with discogenic low back pain without marked lower extremity neurological deficit; 3) one to 3 desiccated discs with or without small, contained herniated nucleus pulposus by T2-weighted magnetic resonance imaging, with at least 50% remaining disc height; 4) concordant pain provocation by low pressure (< 50 psi above opening pressure) discography; and, 5) posterior annular disruption by post-discography computed tomography. Using these patient selection characteristics, approximately 3 of 4 IDET-treated patients should achieve a minimal clinically important improvement in pain and disability.
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Randomized Controlled Trial Comparative Study
Predictors of change in trunk muscle strength for patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises.
We have previously reported in two randomized controlled trials that cognitive intervention and exercises more effectively improved isokinetic trunk muscle strength than lumbar fusion and postoperative rehabilitation in patients with chronic low back pain. The aim of the present study was to predict changes in muscle strength as regard to changes in pain, function, fear-avoidance beliefs (self-rated questionnaires), changes in cross-sectional area and density of the back muscles and treatment. ⋯ Our results emphasize the central role of pain and treatment for the improvements in muscle strength in patients with chronic low back pain.
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Although numerous studies have been published, controversy still exists regarding fusion and nonsurgical treatment for symptomatic degenerative lumbar spine conditions. Definite conclusions are difficult to draw because of differences in patient inclusion criteria, fusion technique, nonoperative treatment regimen, and clinical outcome measures used to determine success. ⋯ Substantial improvement can be expected in patients treated with fusion, regardless of technique, when an established indication such as spondylolisthesis or DDD exists. CLBP patients are less disabled and experience less improvement.
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Arch Phys Med Rehabil · Sep 2008
Randomized Controlled Trial Multicenter StudyIsolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial.
To evaluate the effectiveness of specific lumbar extensor training compared with regular physical therapy (PT) in workers with nonspecific nonacute low back pain (LBP). ⋯ Consistent with prior evidence, specific back strengthening does not seem to offer incremental benefits in LBP management compared with regular PT care that mainly consists of general exercise therapy. (ISRCTN identifier ISRCTN19334317.)
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Southern medical journal · Sep 2008
Randomized Controlled TrialPain relief with intraarticular or medial branch nerve blocks in patients with positive lumbar facet joint SPECT imaging: a 12-week outcome study.
Single-photon emission computed tomography (SPECT) is useful in identifying patients who may respond to lumbar facet injections. There are two methods for performing lumbar facet joint injections: intraarticular and medial branch nerve blocks. A consensus has yet to be reached among physicians as to which method is the most effective. The purpose of this study was to compare the effectiveness of intraarticular and medial branch nerve blocks in SPECT-positive lumbar facet joint patients with nonradicular lower back pain. ⋯ Intraarticular lumbar facet joint injections are more effective than medial branch nerve blocks in SPECT-positive patients.