摘要:

Two hundred chronic low-back pain patients entering a functional restoration program were assessed for current and lifetime psychiatric syndromes using a structured psychiatric interview to make DSM-III-R diagnoses. Results showed that, even when the somewhat controversial category of somatoform pain disorder was excluded, 77% of patients met lifetime diagnostic criteria and 59% demonstrated current symptoms for at least one psychiatric diagnosis. The most common of these were major depression, substance abuse, and anxiety disorders. In addition, 51% met criteria for at least one personality disorder. All of the prevalence rates were significantly greater than the base rate for the general population. Finally, and most importantly, of these patients with a positive lifetime history for psychiatric syndromes, 54% of those with depression, 94% of those with substance abuse, and 95% of those with anxiety disorders had experienced these syndromes before the onset of their back pain. These are the first results to indicate that certain psychiatric syndromes appear to precede chronic iow-back pain (substance abuse and anxiety disorders), whereas others (specifically, major depression) develop either before or after the onset of chronic low-back pain. Such findings substantially add to our understanding of causality and predisposition in the relationship between psychiatric disorders and chronic low-back pain. They also clearly reveal that clinicians should be aware of potentially high rates of emotional distress syndromes in chronic low-back pain and enlist mental health professionals to help maximize treatment outcomes.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patients with sciatica caused by lumbar disc herniation were studied to identify biochemical changes in the cerebrospinal fluid related to myelographic findings and clinical observations. One hundred forty-three patients were evaluated by myelography with regard to involvement of the dural sac and the nerve root. A medial group (20 patients) with evidence of dural sac impingement was compared to a lateral group (63 patients) and an extreme lateral group (9 patients) whose condition primarily affected the nerve root. The remaining 51 patients comprised a mixed group with involvement of both the dural sac and the nerve root. The mean cerebrospina! fluid/serum albumin ratio, cerebrospinal fluid/serum immunoglobulin G ratio, and cerebrospinal fluid total proteins showed a significantly increasing trend from the medial through the lateral to the extreme lateral groups. Patients with lateral lumbar disc herniations more often showed neurologic deficits. These results indicate that the elevated cerebrospinal fluid total protein found in the patients with sciatica is due to leaking of plasma proteins primarily from the nerve root into the cerebrospinal fluid. The cerebrospinal fluid proteins may be used as diagnostic parameters of nerve root compression, especially when surgery is a consideration or in patients in whom sciatica is unlikely.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study examined the role of facet joint morphology in the etiology of both degenerative spondylolisthesis and isthmic spondylolysis. To this end, the axial facet joint morphology of the lower lumbar spine in a normal population and in populations of patients with spinal stenosis or degenerative spondylolisthesis at L4-5 and in patients with isthmic spondylolysis at the L5 level were characterized. Computed tomographic scans were digitized, defining the axial morphology of the normal facet joint at five stations from proximal to distal within the joint. Assessments were made of facet joint orientation, transverse articular dimension, depth of the articular surface, and shape of the articular surface at levels L3-4, L4-5, and L5-S1. There was a gradually more coronal orientation from proximal to distal among the stations at each level, and a maximal transverse articular dimension at the level of the superior endplate of the caudad vertebra. Minimal error in the recording process at this level, in addition to the maximal joint dimension, made this level the most representative of the overall morphology and most useful for further studies. At the L4-5 level, a significantly more sagittal facet orientation was found in the degenerative spondyiolisthesis group when compared to both the normal population and spinal stenosis groups (P< 0.01). At L5-S1, the only significant morphologic difference between the normal population and the patients with isthmic spondylolysis was reduced transverse articular dimension. These results support the hypothesis that patients developing degenerative spondylolisthesis are predisposed to this by a developmental sagittal orientation of the L4-5 facet joints

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Ninety-six patients who had undergone first-time discectomy for herniated lumbar intervertebral discs were consecutively randomized to two physical rehabilitation programs: a program of high-intensity, dynamic back extension and abdominal exercises with occurrence of low back pain being the limiting factor or a traditional program of mild, generally mobilityimproving exercises within pain limits. Both groups underwent 14 hours of treatment during a 6-week period 5 weeks after surgery.At 26 weeks' follow-up, results indicated that patients who did the high-intensity exercises experienced greater success with regard to the patient disabilityindex and work capabilities. After 1 year, a trend that favored the use of intensive exercises could be observed. No differences were found in pain or objective measurements.A rehabilitation program of intensive exercises with occurrence of back pain being the limiting factor appears to increase patient behavioral support, resulting in work capacity improvements and patient self-rated disability levels. The results indicate that a 6-wk, 14-hr postoperative rehabilitation program is inadequate if objective postoperative deficit improvements are the desired goal.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In a randomized, observer-blind trial, 150 men and women, aged 21-64 years, with chronic/subchronic low-back pain, followed one of these three treatment regimens: 1) intensive, dynamic back-muscle exercises; 2) conventional physiotherapy, including isometric exercises for the trunk and leg muscles; and 3) placebo-control treatment involving semihot packs and light traction. Eight treatment sessions were given during the course of 4 weeks, each session lasting 1 hour. The short-term effect was evaluated at the end of the treatment period and 1 month later, and the long-term effect at 6 and 12 months. The evaluations included recording of changes in pain level and assessment of overall treatment effect, which were indicated on visual interval scales.Subgroups of patients could be identified according to their treatment responses: physiotherapy was the superior treatment for the male participants, whereas the intensive back exercises appeared to be most efficient for the female participants. Patients with moderate or hard physical occupations tended toward a better response with physiotherapy, whereas intensive back exercises seemed most effective for those with sedentary/light job functions.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Two examples of a marked defect of the corner of the vertebral body adjacent to an intervertebral disk herniation are presented. The prevalence of this finding was assessed in 43 randomly selected patients with disk herniation (at 46 levels). None of these patients had such marked vertebral defects (moderate changes at 3 levels; minor in 23). Although the defects were seen more often in younger patients, adjacent to large herniations, and in those with substantial cranial or caudal migration, these associations did not reach statistical significance. However, the site of the defect, when associated with disk migration, correlated with the direction of the migration. It is considered likely that this defect is caused by a purely mechanical effect, but its possible relationship to developmental factors is discussed.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The twisting mobility of the back was measured using an electromagnetic measuring device, the 3SPACE Isotrak, in ten healthy subjects in five postures: standing upright, in two forward-leaning positions, and two seated positions. In the forward-leaning positions the subjects flexed with mean values of 28° and 53° and had no difference in their active twisting compared with that experienced in the upright position. The two seated positions induced mean flexion values of 32° and 44° and were associated with statistically significant increases in active twisting compared with the upright position of 38% and 46%, respectively, at the level of P<0.0001. These increases suggest that the wedge morphology of the zygapophysial joints permits greater twisting when the intervertebral joints are flexed, but postural muscle action in forward leaning restricts active twisting. This study suggests a mechanism for increased vulnerability of the posterior anulus to injury when twisting is combined with flexion.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The aim of this study was to determine the clinical validity of functional flexion/extension radiographs of the cervical spine in a defined patient population. Sixty-four adults with functional disorders of the cervical spine underwent passive flexion/extension radiographic examinations. The radiographs were analyzed using a computer assisted method to calculate segmental motion parameters, such as rotations, translations, and centers of rotation. The patients were separated into three groups based on their specific functional disorders, and their motion parameters were compared with those of a healthy population. The three groups consisted of patients with degenerative changes, those with radicular syndrome, and those with whiplash trauma. Most of the patients displayed trends toward hypomobile segmental motion. This trend is displayed more substantially in the groups with degeneration and radicular syndrome. Hypomobility in segmental rotation was significant at C6-C7 for the degenerative and radicular groups. The trauma group showed trends toward hypermobility in the upper and middle cervical levels, and the locations of the centers of rotation were shifted in the anterior direction when compared with those of the healthy population.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Seventeen specimens of lumbar discs, attached to the caudal and cranial halves of the adjacent vertebral bodies, were subjected to a maximum compressive load of 5.5 kN in six stages. The time between each stage was about 15 seconds. At each stage of compression, a radiograph of the specimen was recorded, and the bulging of the end-plate into the caudal vertebra was measured using a displacement transducer. After compression, the ash content of a bone sample and the water content of a sample of the nucleus of the disc were measured for each specimen. Sections through the specimens were examined by light microscopic study. Eight specimens did not fail, although end-plate displacement occurred during compression. The remaining nine specimens experienced fracture or permanent deformation of the end-plate. Specimens that failed had significantly lower rigidity of the end-plate and underlying trabecular bone; this rigidity was correlated with bone ash content.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study was aimed at investigating, in relating to aging, some of the biochemical and biophysical characteristics of the facet cartilage that determine the functional behavior of this tissue. In addition, facets and discs from the same segment were graded according to their macroscopic appearance. The proportion of severely degenerate discs was low in young subjects and increased with age; by contrast, the proportion of coarsely fibrillated and/or ulcerated facets was high in spines from young adults and remained constant throughout adulthood.Unlike discs, facets do not show an age-related loss of proteoglycans or a consequent decrease in the resistance to a compressive load. However, even in relatively young age groups (30-50 years) a high hydration was observed more often in facet joints than in cartilage from other joints studied. These characteristics are known to accompany damage of the collagen network and cartilage degeneration. Unlike normal femoral head cartilage, facet cartilage does not show a rise in fixed charge density with age. The cartilage from the superior processes (concave) is thicker than that from the inferior processes (convex) and has a higher fixed charge density. At the same time it has a higher water content, which indicates that damage occurs more frequently.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID