Articles: low-back-pain.
-
Z Orthop Ihre Grenzgeb · May 1993
Review[Long-term results following percutaneous facet coagulation].
93 patients with a mean follow up of 73 months (30-133 months) after lumbar percutaneous radiofrequency denervation (PRFD) were evaluated. Mean age of the patients at time of surgery was 47 years (18-76 years). 54 patients had no lumbar spine surgery prior to facet denervation, 32 patients had one or multiple disc surgery prior to denervation, and 7 patients had spinal fusions. 51 patients were in the process of early retirement or already retired at time of surgery. Out of all 93 patients only 50% had significant pain relief immediately after PRFD. 3 months after PRFD the success rate dropped down to 38%. 6 years after surgery only 25% of all patients had long lasting good results. Patients who were pain free after facet infiltration had significant better initial results, but were similar to the others after 6 years. 6 out of 7 patients after lumbar spinal fusions demonstrated bad results. The worst results had those patients who had applied for early retirement (workmens compensation cases). In this group the recurrence rate was 74% 6 years after surgery. We found no correlation between the surgeon and the outcome. ⋯ Without pain reduction after facet infiltration the success rate after PRFD is low. Spinal surgery prior to PRFD significantly reduces the success rate. The worst prognosis have workmans compensation cases. The recurrence rate is high within the first 6 months after PRDF.
-
To help clarify the nature of coping activities in chronic pain, this study compared how depressed (n = 37) and non-depressed (n = 40) chronic low back pain (CLBP) patients attempted to cope with pain-specific and general non-pain life stressors, relative to matched healthy control subjects (n = 40). We hypothesized that depressed mood, rather than pain alone, would account for differences in coping activities between groups. Specifically, we expected that depressed CLBP patients would report a greater proportion of passive and avoidant coping responses and less active problem solving coping attempts than non-depressed patients and controls. ⋯ Additionally, subjects across groups tended to report more passive-avoidant coping in response to the specific back pain stressor (i.e., exacerbation of back pain during activity) than to other life stressors. Finally, the magnitude of reported differences in coping attempts across groups varied as a function of the type of stressor (i.e., specific back pain stressor vs. general stressful life events), particularly with regard to a disinclination to seek social support in response to the back pain exacerbation. We conclude that: (1) chronic back pain patients may employ different coping activities when attempting to manage pain exacerbations than when confronting more general life stressors, and (2) an increased rate of passive-avoidant coping responses (relative to matched health controls) is associated with the combination of CLBP and concurrent depressed mood, rather than with CLBP alone.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Methods for detecting recruitment patterns of the lumbar muscles during exercise in patients with chronic low back pain are limited. This article discusses the use of magnetic resonance imaging with Roman chair extension exercise to examine lumbar muscle usage in five normal volunteers, five chronic low back pain patients without surgery, and five chronic low back pain patients with surgery. Changes in signal intensities of psoas, multifidus, and longissimus/iliocostalis with graded exercise were measured at three lumbar disc levels. ⋯ At peak exercise, there was a difference in signal intensities between multifidus and longissimus/iliocostalis in all groups (normal volunteers, P = 0.0069; chronic low back pain patients without surgery, P = 0.0125; chronic low back pain patients with surgery, P = 0.0060). The exercise response was attenuated in chronic low back pain patients with surgery. Thus, MRI demonstrates static and dynamic differences in lumbar paraspinal musculature in chronic low back pain subjects compared to normal subjects.
-
Current ergonomic techniques for controlling the risk of occupationally-related low back disorder consist of static assessments of spinal loading during lifting activities. This may be problematic because several biomechanical models and epidemiologic studies suggest that the dynamic characteristics of a lift increase spine loading and the risk of occupational low back disorder. It has been difficult to include this motion information in workplace assessments because the speed at which trunk motion becomes dangerous has not been determined. ⋯ The predictive power of this model was found to be more than three times greater than that of current lifting guidelines. This study, though not proving causality, indicates an association between the biomechanical factors and low back disorder risk. This model could be used as a quantitative, objective measure to design the workplace so that the risk of occupationally-related low back disorder is minimized.
-
Thirty-six 45-55-year-old men with healthy low backs were studied with respect to body composition, isokinetic and isometric trunk strength, trunk muscle endurance, and cross-sectional area and radiological density of mm erector spinae. Results were compared to those of men in the same age group with intermittent low back pain (LBP) (n = 91) and with chronic LBP (n = 21). The back healthy group was significantly stronger and had longer trunk muscle endurance times than men with chronic LBP. ⋯ There were no significant differences between any of the groups with respect to body composition and cross-sectional area of mm erector spinae. Radiological density for mm erector spinae was significantly decreased in the chronic LBP group compared to the back healthy and intermittent LBP groups. The deconditioning syndrome and its relationship to intermittent and chronic LBP is discussed.