摘要:

Study DesignThis cross-sectional study compares the Oswestry and Roland-Morris disability scales in two groups of patients with low back pain of different clinical and electromyographic severity.ObjectivesTo evaluate the correlation between functional disability and diagnoses.Summary of Background DataThere is an increasing need for functional disability measurements to be applied to the evaluation of therapy and outcome in patients experiencing low back pain.MethodsTwo very different groups of patients with low back pain completed the Oswestry and Roland-Morris self-administrated functional disability questionnaires. One group included patients presenting with an episode of mechanical low back pain with no clinical radiculopathy. The other group consisted of patients with low back pain and clinical and electromyographic evidence of radiculopathy.ResultsPatients diagnosed with low back pain who exhibited signs of radiculopathy on electromyography had a mean score of 49.1 ± 17.1 on the Oswestry disability questionnaire; a mean score of 33.0 ± 14.7 was found for patients who experienced “simple” low back sprain (with no radiculopathy). This difference was statistically significant (P< 0.0001). On the Roland-Morris questionnaire, the mean score obtained by the group of patients with radiculopathy was 59.1 ± 21.8 compared with 45.4 ± 19.4 for those with no radiculopathy. This difference was also statistically significant (P< 0.0001). Moreover, there exists a moderate correlation between both functional scales within each group of patients: 0.72 (P< 0.0001) in the group with radiculopathy and 0.66 (P< 0.0001) among those without radiculopathy.ConclusionsThe authors conclude that both functional disability scales accurately discriminated between these two groups of patients with low back pain of very different clinical and electromyographic severity.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Study DesignAn analysis of clinical data gathered at an orthopedic outpatient clinic is presented.ObjectiveTo examine the relationship between Waddell scores and the Minnesota Multiphasic Personality Inventory response patterns.Summary of Background DataWaddell's study of nonorganic signs of low back pain showed consistent correlations with Minnesota Multiphasic Personality Inventory scales 1 to 3.MethodsA Waddell score was obtained from 507 consecutive patients with chronic low back pain to whom an Minnesota Multiphasic Personality Inventory also was administered. The sample was divided into those patients with a high Waddell score (high waddell score = 3 to 5) and those with a low Waddell score (low waddell score = 0 to 2); men and women were scored separately.ResultsAmong male patients, statistically significant differences were found between the high Waddell score and low Waddell score groups on Minnesota Multiphasic Personality Inventory scales 1, 3, and 8, but among females, differences were statistically significant only on scale 8.ConclusionsCorrelations between the Waddell score and the first three scales of the Minnesota Multiphasic Personality Inventory were not fully replicated. The difference between the high Waddell and low Waddell groups on scale 8, however, was significant for men and women.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Study DesignA retrospective, descriptive study.ObjectivesTo describe the diagnostic and therapeutic procedures for patients with chronic low back pain in primary care.Summary of Background DataMost previous studies have described the management of acute low back pain, but little is known about the management of chronic low back pain in primary care.MethodsTwenty-six general practitioners involved in the Registration Network of Family Practices of the University of Limburg in The Netherlands participated in this study. All patients and general practitioners were asked to complete a retrospective questionnaire, and there was a 12-month follow-up.ResultsThe total study population consisted of 524 patients with chronic low back pain. Twenty-three percent of the patients had had radiographs taken during the previous 12 months, and 5% had been examined by other imaging techniques. Twenty-nine percent of the study population had not received any therapy at all, 46% had received medication, mostly (36%) nonsteroidal anti-inflammatory drugs (NSAIDs), and for 18% (bed)-rest had been advised. Thirty-six percent of the study population had been referred to a physiotherapist.ConclusionsThe therapeutic management of chronic low back pain seems to lack consistency. Clinical guidelines are needed to improve the management of chronic low back pain in primary care.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Study DesignNine patients with thoracolumbar burst fractures associated with horizontal fractures in the posterior column were studied retrospectively.ObjectivesTo clarify the clinical and radiographic findings and evaluate the postoperative results for this type of fracture.Summary of Background DataIt is not well recognized that burst fractures occasionally are accompanied by horizontal fractures of the posterior column such as those that result from seatbelt-type injuries. This type of burst fracture differs from flexion-distraction injuries combined with burst fracture, which are accompanied by horizontal fractures not only in the posterior but also in the middle column. Radiographic features of these two different types of injuries are very similar to each other, and their differentiation in diagnosis and treatment has not been recognized clearly.MethodsPatients were reviewed using a combination of clinical records, follow-up examination, and radiographic data (computed tomography [CT], plain radiographs, and tomographs). Anterior spinal fusion was performed in eight patients using the Kaneda device (Mizuhoika, Tokyo, Japan), and one was treated by posterior fusion with pedicle screw fixation. The average follow-up period was 4 years.ResultsPatients with fractures of this type represented 21% of the 48 patients with thoracolumbar burst fractures. The injury was sustained by falling in all nine patients. All of the burst fractures were Denis' type B. The horizontal fracture was located at the lamina and spinous process in the posterior column of the upper vertebra adjacent to the involved vertebra in all nine patients. The integrity of the ligamentous structures of the middle column, such as the posterior longitudinal ligament, the periosteum, and the outermost anulus, was confirmed at surgery in eight patients, although not in the patient who underwent posterior fusion. One patient required surgery because of progression of kyphotic deformity during conservative treatment. Solid fusion with no complications was noted in all patients.ConclusionThis type of burst fracture is not accompanied by ligamentous injuries because of distraction force in the middle column, which is not present in flexion-distraction injuries, but it seems to be more unstable than burst fractures with no horizontal splitting of the posterior column and requires surgical stabilization.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Telemedicine-the delivery of health care services to the underserved through communications technologies-has the potential to bring medical care to remote areas where health care is either inadequate or nonexistent. Telemedicine can be something as simple as a phone call, a network transmission of a radiograph or other diagnostic image, or, much more advanced, realtime video surgical consultations from anywhere on the globe. Telemedicine programs operate throughout Europe, Japan, and Australia. International programs, for-profit and nonprofit, serve Asia, Africa, and the Middle East.The United States is also a major telemedicine developer, principally through government agencies such as the Department of Defense and the Office of Rural Health Policy, and, to a lesser extent, the private sector. But telemedicine in the United States has yet to prove itself economically viable, and it faces a number of political and regulatory barriers. Even more significantly, telemedicine's potential to increase overall health care spending by increasing access to health care has deterred private industry from investing heavily in it. In the short term, telemedicine's most important contribution to health care may be raising fundamental questions about United States health care policy.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Pain is an extremely complex process that involves the interaction of an array of neurotransmitters and neuromodulators at all levels of the neuraxis. Identification of the receptors and processes that are involved in the transmission of pain at a spinal level has led to the use of new agents and new techniques in pain management. These include use of preemptive analgesia and use of techniques such as intrathecal drug administration and epidural spinal cord stimulation. This review presents some of the findings from basic research that have led to these developments, particularly those that relate to the changes that occur following inflammation and nerve injury.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Study DesignThis case report describes a patient with epidural hematoma of the lumbar spine and progressive intermittent claudication whose imaging findings were similar to those of a patient with extruded disk herniation.ObjectivesTo highlight the diagnosis and cause of the lumbar epidural hematoma.Summary of Background DataThe characteristics of imaging of lumbar epidural hematomas have been reported. To the authors' knowledge, a case of epidural hematoma with leakage of the contrast medium into the mass at discogram has never been reported.MethodsA case of a lumbar epidural hematoma with 10-15 minutes of intermittent claudication was described. There was no history of major trauma or coagulation disorders. Diagnosis was made using magnetic resonance imaging, myelography, discography, and computed tomography. The magnetic resonance image demonstrated a relatively large, rounded mass posterior to the S1 vertebral body with L5-S1 disc protrusion. A gadolinium-enhanced magnetic resonance image showed a rim-enhancing lesion. A discogram revealed leakage of the contrast medium into the mass. The mass was diagnosed as extruded disk herniation, and surgery was performed.ResultsAt surgery no evidence of obvious disk herniation was detected, but the encapsulated hematoma was found.ConclusionsA case of chronic lumbar epidural hematoma in which clinical and imaging findings were similar to those of an extruded lumbar disk herniation was reported. Clinical information and results of imaging studies should be analyzed carefully because the imaging findings of contained epidural hematomas are often quite specific to this condition and can be differentiated from those of extruded disc herniations. Management of chronic lumbar epidural hematoma may be altered by a specific diagnosis.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Study DesignA case study of a previously unreported complication of unsuccessful broken pedicle screw removal in the thoracolumbar spine is presented.ObjectivesTo emphasize an increased awareness of the potential for large vessel injury during difficult broken pedicle screw removal in the thoracolumbar spine and to encourage the thorough evaluation of indications for the removal of any broken distal fragment in a vertebral body.Summary of Background DataReported complications of pedicle screw removal include the inability to remove the distal screw fragment, nerve root injury, and dural sheath violation. Damage to anterior vascular structures, including the vena cava, iliac arterial and venous systems, and aorta, has not yet been reported in association with difficult broken pedicle screw removal.MethodsAn instrument designed to capture the distal end of a screw fragment through an interference fit resulted in inadvertent screw migration into the retroperitoneal space. Plain roentgenograms and computed tomography were used to document this complication, revealing the close proximity of the screw fragment to the aorta.ResultsExpedient recognition of the anteriorly migrated screw fragment with its subsequent removal resulted in a satisfactory outcome.ConclusionGreat care must be taken during the removal of broken pedicle screws to prevent injury to surrounding structures. Additionally, indications for the removal of distal screw fragments must be carefully established. Instruments designed to capture the end of the distal screw fragment through an interference fit may allow anterior screw migration to occur, particularly in osteoporotic bone.

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1997

数据来源: OVID