摘要:

Study Design.A cross-sectional survey using patient questionnaires was conducted.Objective.To assess whether the Roland Disability Questionnaire satisfies the Rasch model including unidimensionality and item separation.Summary of Background Data.The Roland Disability Questionnaire, the most widely used patient-assessed measure of health outcome for back pain, has undergone several evaluations for its measurement properties including reliability, validity, and responsiveness. However, there is no published work relating to the underlying dimensionality of the instrument and the extent to which individual items contribute to the construct of physical disability resulting from low back pain.Methods.Patients entering a randomized controlled trial of exercise, manipulation, and usual management for back pain completed a questionnaire that included the Roland Disability Questionnaire. The Winsteps program was used to assess whether the Roland Disability Questionnaire fits the Rasch model. Item fit was assessed using the Infit and Outfit statistics.Results.The Roland Disability Questionnaire was completed by 1008 (90%) of the patients taking part in the trial. Most of the items in the Roland Disability Questionnaire contribute to a single underlying construct. However, four items had poor Outfit statistics, suggesting that they do not contribute sufficiently to the scale hierarchy. Several items positioned around the middle of the hierarchy are not sufficiently distinct in terms of difficulty. There were very few items positioned at the extremes of the hierarchy.Conclusions.The Roland Disability Questionnaire largely satisfies the Rasch model for unidimensionality. However, the instrument could be improved through the removal of poorly fitting items and the addition of items at the upper and lower points of the scale hierarchy. The distribution of Roland Disability Questionnaire scores should be carefully considered before statistical testing is undertaken. Rasch transformed scores can be used to deal with deficiencies in the scale hierarchy.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Nerve root blood flow was intraoperatively measured before and after discectomy for lumbar disc herniation and compared with clinical features.Objective.To investigate the relation between nerve root blood flow changes and symptoms associated with lumbar disc herniation.Summary of Background Data.Several authors have reported that recovery of intraneural blood flow, which restores the supply of oxygen and other nutrients to the nerve tissue, is strongly related to the rapid improvement of nerve function after discectomy for lumbar disc herniation. However, no previous study has quantitatively assessed blood flow in the human nerve rootin vivo.Methods.Nerve root blood flow was monitored in 21 patients with lumbar disc herniation using laser Doppler flowmetry (ALF 21 N; ADVANCE, Tokyo, Japan) during discectomy. Possible correlations were investigated between the blood flow rates and the following clinical features: age, duration of sciatica, presence or absence of neurologic deficits, latency to pain relief, and morphology of herniated discs.Results.The blood flow rate in 16 patients who reported immediate relief after discectomy was much greater than in 5 patients whose pain was not relieved immediately after surgery (141%vs8%,P= 0.0364). The increase in the blood flow rate after discectomy was five times greater in patients with neurologic deficits than in patients without neurologic deficits (158%vs36%,P= 0.0638).Conclusions.The results of the current study suggest that immediate relief from pain and resolution of neurologic deficits soon after surgery are the result of early recovery from nerve root ischemia after discectomy, and that ischemia caused by mechanical nerve root compression is mainly related to the mechanisms underlying sciatic pain production and neurologic deficits.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Study Design.Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients).Objectives.To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique’s safety, short-term complications, and accuracy.Summary of Background Data.Pedicle screw instrumentation is safe and effective for lumbar spine stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking.Methods.Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placedviaintraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans. Instrumentation failure prevalence was determined by review of fluoroscopic images, postoperative radiographs, and computed tomography scans. Neurologic, infectious, vascular, and gastrointestinal complications were determined by review of operative reports, hospital records, and clinic notes.Results.Of the 126 (50%) thoracic screws (22 patients) with postoperative computed tomography scans, 16 (12.7%) penetrated the pedicle cortex (4 [2.4%] medially and 13 [10.3%] laterally) and 7 (5.6%) penetrated the vertebral body. There were four surgical complications: one instrumentation failure (broken rod, no loss of correction), one deep infection, and two superficial infections. The infections resolved with irrigation, debridement, and intravenous antibiotics. During the 6- to 24-month follow-up period, there were no neurologic, vascular, or gastrointestinal complications.Conclusions.Cervicothoracic, thoracic, and thoracolumbar spine injuries can be managed safely and effectively with thoracic pedicle screws inserted under multiplanar fluoroscopic imaging.

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2003

数据来源: OVID