Articles: low-back-pain.
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The purpose of this study was to determine the intertherapist reliability of judgments of stiffness and pain at L-1 to L-5 made using posteroanterior (PA) central pressure testing. ⋯ Judgments of stiffness made by experienced manipulative physical therapists examining patients in their own clinics were found to have poor reliability, whereas pain judgments had good reliability. Further investigation of this test is required in order to develop a more reliable method of assessing PA stiffness.
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Clinical Trial
The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints.
One hundred and seventy-six consecutive patients with chronic low back pain and no history of previous lumbar surgery were studied to determine the false-positive rate of single diagnostic blocks of the lumbar zygapophysial joints. All patients underwent diagnostic blocks using lignocaine. Those patients who obtained definite or complete relief from these blocks subsequently underwent confirmatory blocks using bupivacaine. ⋯ Using the response to confirmatory blocks as the criterion standard, the false-positive rate of uncontrolled diagnostic blocks was 38% and the positive predictive value of these blocks was only 31%. Because the positive predictive value of a test is lower when the pre-test probability (prevalence) is low, and because the prevalence of lumbar zygapophysial joint pain is likely to be less than 50%, uncontrolled diagnostic blocks will always be associated with an unacceptably low positive predictive value. These features render uncontrolled diagnostic blocks unreliable for the diagnosis of lumbar zygapophysial joint pain not only in epidemiologic studies but also in any given patient.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Pain from the lumbar zygapophysial joints: a test of two models.
One hundred seventy-six consecutive patients with chronic low-back pain and no history of previous lumbar surgery were studied to test the clinical criteria of Fairbank et al. and Helbig and Lee for zygapophysial joint pain. All patients underwent a history, examination, and a series of zygapophysial joint injections or blocks of the medial branches of the dorsal ramus with lignocaine. ⋯ None of the clinical features tested was found to be associated with response to the confirmatory block. The Fairbank et al. and Helbig and Lee criteria were shown to be unreliable in distinguishing pain of zygapophysial joint origin from pain of other origins.
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AJNR Am J Neuroradiol · Aug 1994
Enhanced lumbar nerve roots in the spine without prior surgery: radiculitis or radicular veins?
To evaluate the clinical significance of continuous intradural lumbosacral nerve root enhancement in symptomatic patients without prior lumbar surgery. ⋯ Lumbosacral nerve root enhancement correlates poorly with clinical radiculopathy. The use of contrast enhancement to detect lumbosacral nerve root enhancement in cases in which the unenhanced scan is less than diagnostic is not warranted. The high association between lumbosacral nerve root enhancement and entry-section flow-related enhancement suggests that these enhancing structures within the cauda equina are vessels. It is likely that lumbosacral nerve root enhancement represents intravascular enhancement of radicular veins and not a breakdown in the blood-nerve barrier.
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Comparative Study Clinical Trial Controlled Clinical Trial
Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study.
A global and segmental study on standing lateral radiographs of 100 volunteers and 100 patients who had low back pain was undertaken to further define sagittal plane alignment and balance. The volunteer control group and the patient group were matched for age, sex, and size. ⋯ Definitions of sagittal balance are provided as well as additional sagittal plane data by which to compare corrections and fusions for different spinal disorders.