Articles: low-back-pain.
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Imaging strategy varies according to the background of acute or persistent low back pain. In case of acute low back pain with associated symptoms of a cauda equina syndrome or any atypical clinical signs PA and lateral radiographs of the lumbar spine are required. ⋯ Secondary, MRI may be performed in case of worsening and persistence of the clinical symptoms or if a specific low back pain is suspected. In case of chronic low back pain, with a severe socio-professional impact or a planed invasive treatment, plain films of the lumbar spine must be obtained, eventually with additional MRI examination.
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Surgical treatment of the low-back pain remains controversial in term of efficacy. Surgical treatment is advocated only when conservative management fails, a clearly identifiable cause of lumbar pain is identified, worker's compensations are detected, psychological disorders are treated and disability and pain are still present. ⋯ Spinal fusion provide 50-93% of clinical success in the literature, spondylolisthesis remains the better indication. Only 30% returning to work were obtained.
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Degenerative processes in the disc and facet joints affect the stability of the motion segment. The exact relations among disc degeneration, facet joint osteoarthritis, and the kinematics of the motion segment are not well defined in the literature. Magnetic resonance imaging and functional radiography of the lumbar spine were analyzed to examine the relations among segmental instability, facet joint osteoarthritis, and disc degeneration in patients with degenerative disorders of the lumbar spine. ⋯ Abnormal tilting movement on flexion and anteroposterior translatory instability both had negative associations with facet joint osteoarthritis. However, anterior translatory instability was positively associated with disc degeneration and facet joint osteoarthritis. Rotatory instability in the sagittal plane and posterior translatory instability were not associated with disc degeneration and facet joint osteoarthritis.
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Comparative Study
Patient characteristics and patterns of use for lumbar spine radiographs: results from the Veterans Health Study.
Longitudinal data from the Veterans Health Study, an observational study of male patients receiving Veterans Administration ambulatory care, were analyzed. ⋯ Both physical and psychological factors contribute to having new radiographic examinations, whereas psychological factors have increased importance in the repeat use of roentgenographic examinations. Repeat radiographs appear to be overused, judging by the severity of physical impairment as measured by low back pain intensity, the Medical OutcomeStudy Short Form Health Survey, and disability days.
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Review Comparative Study
Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.
A systematic review of randomized and double-blind controlled trials was performed. ⋯ The evidence from the 51 trials included in this review suggests that nonsteroidal anti-inflammatory drugs are effective for short-term symptomatic relief in patients with acute low back pain. Furthermore, there does not seem to be a specific type of nonsteroidal anti-inflammatory drug that is clearly more effective than others. Sufficient evidence on chronic low back pain still is lacking.