Articles: low-back-pain.
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Review
Low back pain: what is the long-term course? A review of studies of general patient populations.
It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim--attractive as it might be to some--may not reflect reality. ⋯ The risk of LBP was consistently about twice as high for those with a history of LBP. The results of the review show that, despite the methodological variations and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored. Future research should include subgroup analyses and strive for a consensus regarding the precise definitions of LBP.
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Orthop. Clin. North Am. · Apr 2003
ReviewIndications, techniques, and outcomes of posterior surgery for chronic low back pain.
This article summarizes a number of issues surrounding the diagnosis, indications, and techniques of posterior lumbar spine surgery for chronic low back pain. It would not be entirely unjustified for a spine surgeon to adhere to a totally avoidant approach to chronic low back pain, rationalized by a reasonably legitimate nihilism regarding the presently available means of diagnosing and surgically managing low back pain [64]. Judging by the number of lumbar fusions performed in North America and the tremendous intellectual and financial investment currently being made in technologies to enhance spinal fusion, such an approach is evidently not achieving wide-spread acceptance on this continent. ⋯ Every effort should be made to establish a pathoanatomic etiology of the back pain with a combination of diagnostic modalities. Surgical intervention should be approached cautiously and only after extensive dialog with the patient to establish realistic goals and expectations. Posteriorly performed interbody fusion procedures may provide a high fusion rate and satisfactory clinical outcomes for this challenging problem, although further research is necessary to determine more conclusively the role of surgery and the relative effectiveness of the various arthrodesis techniques.
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Clin. Orthop. Relat. Res. · Apr 2003
Comparative StudyCircumferential and posterolateral fusion for lumbar disc disease.
Clinical outcome of low back fusion is unpredictable. There are various reports discussing the merits and clinical outcome of these two procedures. The patients were selected from a population of patients who had chronic low back pain unresponsive to conservative treatment. ⋯ The posterolateral fusion group had a 63.9% satisfactory outcome and the posterior lumbar interbody fusion group had an 80% satisfactory outcome using the Oswestry disability index for postoperative assessment. There was 61.1% improvement in working ability in the posterolateral fusion group and 77.1% improvement in the posterior lumbar interbody fusion group which was not statistically significant. The authors consider instrumented circumferential fusion with posterior lumbar interbody fusion better than instrumented posterolateral fusion for managing chronic disabling low back pain.
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To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities. ⋯ The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.
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Reliability and ease of use of the Itrel 3 System (Medtronic Inc., Minneapolis, MN) were prospectively assessed over 5 years in patients with a range of pain syndromes (mainly low back and/or leg pain, or ischemic pain due to peripheral vascular disease). The longevity of the implantable pulse generator (IPG) battery, the frequency with which system settings were changed, and the ease of use of the EZ patient programmer were assessed. Data on adverse events, pain relief, and patient satisfaction with therapy were also collected. ⋯ The intensity and duration of pain were reduced significantly and patient satisfaction with therapy was high. We conclude that the Itrel 3 System performed well over 5 years and was easy to use. Its safety and effectiveness for the relief of chronic intractable pain of the trunk or limbs were also confirmed.