Articles: low-back-pain.
-
Case Reports
Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis.
The aims of the current study were to evaluate the long-term clinical and radiologic results of anterior lumbar interbody fusion (ALIF) for isthmic spondylolisthesis. Between 1981 and 1988, a total of 35 patients underwent ALIF for isthmic spondylolisthesis. Of these, 23 patients were followed clinically and radiographically for more than 10 years (average, 13.3 years). ⋯ The rate of union in the grafted area was 83%. In the nonunion cases, the scores gradually deteriorated with time, but the overall results were not different from those of union cases. Radiographs showed adjacent disk degeneration in 52% of cases in the upper adjacent level and in 70% of cases in the lower adjacent level, but these changes were not correlated with clinical outcomes.
-
Balance performance in unstable sitting and trunk muscle response to quick force release were measured in 16 patients with chronic low back pain and 14 matched healthy control subjects. ⋯ Patients with chronic low back pain demonstrated poorer postural control of the lumbar spine and longer trunk muscle response times than healthy control volunteers. Correlation between these two phenomena suggests a common underlying pathology in the lumbar spine.
-
A reliability study was performed. ⋯ The reliability was found to be acceptable for the Astrand test and the isokinetic test at 60 degrees per second, as evaluated by the critical difference. All the tests were highly reliable according to the intraclass correlation coefficient, except for Biering-Sørensen test for healthy individuals. The critical difference is the preferable measure because calculation of the intraclass correlation coefficient may give a misleading high estimate of reliability.
-
Epidural fibrosis is seen as a common phenomenon among postlumbar laminectomy syndrome patients, contributing to approximately 60% of symptom recurrence. Percutaneous epidural lysis of adhesions has been described as a modality to effectively manage chronic low back pain secondary to epidural fibrosis. Forty-five patients were randomly assigned, with fifteen patients in the control group, or Group I, who were treated with conservative modalities of treatments, including medication, physical therapy, and an exercise program; and, thirty patients in Group II, who were treated with percutaneous epidural adhesiolysis and hypertonic saline neurolysis. ⋯ The study also showed that overall health status improved significantly in the treatment group in all parameters with average pain, physical health, mental health, functional status, psychological status and narcotic intake. Analysis also showed that this is a cost-effective treatment, with cost for 1-year improvement of quality of life at $2693. In conclusion, epidural adhesiolysis with hypertonic saline neurolysis performed on a 1-day basis is an effective modality of treatment in managing chronic low back pain in patients who failed to respond to fluoroscopically directed epidural steroid injections and also were demonstrated not to have facet joint mediated pain.
-
Review Meta Analysis
A critical review of reviews on the treatment of chronic low back pain.
Systematic literature review. ⋯ Although the overall quality of systematic reviews was satisfactory, the quality of the individual papers included in the reviews varied considerably. The reviews often provided contradictory evidence on the effectiveness of a wide range of commonly used conservative interventions for chronic nonspecific low back pain. These findings illustrate the pitfalls of systematic reviews where there are a number of low-quality trials and underscore the need for high-quality primary trials that will allow for more conclusive reviews.