Articles: low-back-pain.
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J Bone Joint Surg Am · Feb 2007
Comparative StudyElectromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms.
Magnetic resonance imaging is commonly used to diagnose lumbar spinal stenosis. Some persons without symptoms have a small lumbar spinal canal. Electrodiagnosis has been used to diagnose spinal stenosis for over sixty years, but we are aware of no masked, controlled trials of the use of electrodiagnosis for that purpose. This study was performed to evaluate the relationships of magnetic resonance imaging measures and electrodiagnostic data with the clinical syndrome of spinal stenosis. ⋯ This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis.
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AJNR Am J Neuroradiol · Feb 2007
Comparative Study Clinical TrialComparison of the temporary diagnostic relief of transforaminal epidural steroid injection approaches: conventional versus posterolateral technique.
Conventional transforaminal epidural steroid injection (TFESI) has several problems. The purpose of this study was to compare the temporary diagnostic relief and advantages of TFESI performed using the conventional and posterolateral approaches. ⋯ Our findings suggest that the posterolateral approach is an alternative method for TFESI in cases where needle tip positioning in the anterior epidural space is difficult.
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Curr Pain Headache Rep · Feb 2007
ReviewInterventions for low back pain: what does the evidence tell us.
Although interventional therapy for chronic spinal pain continues to be popular among patients and providers, the scientific evidence supporting these techniques has lagged behind their presence in the market. This article collates both classic and more recent experimental results involved in the interventional assessment and treatment of chronic spinal pain, and presents key findings for physicians. Although much of the body of evidence is either unsupportive or inconclusive, there are some definitive findings involving each technique that can help shape rational practice. As interventional pain medicine seeks to become a more validated specialty, introspection and advancing science will be key to this development.
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Low back pain is estimated to affect 80% of the general population at least once in their lifetime. It is the fifth leading cause of medical clinic visits and the leading work-related disability. Lumbar discography has been used to diagnose the source of low back pain when non-invasive imaging, such as magnetic resonance (MR), does not reveal morphologic abnormality consistent with symptoms. ⋯ These causes of positive pain provocation are not amendable to invasive treatment. In these cases, an invasive diagnostic procedure to identify problems best treated with conservative management is not practical. The conclusion of this review found no clear evidence-based purpose for discography in the diagnosis and treatment of low back pain.
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The purpose of this study was to determine the accuracy of manipulative physiotherapists in palpating radiologically identified lumbar spinous processes (SPs). Five experienced manipulative physiotherapists were each allocated a cohort of 15 consecutive low back pain (LBP) patients presenting for X-rays and were asked to use surface palpation to identify the L1, L3 and L5 SPs. Spherical radio-opaque markers were taped to the skin over these palpated points and standard lateral radiographs taken. ⋯ The strongest effect on accuracy was between-therapist variability. The manipulative physiotherapists used in this study appear to be moderately successful in either palpating a nominated SP or being no more than one spinal level in error. Further research will focus on the choice of palpation procedure and a larger sample.