摘要:

Study Design.A morphometric study of the lateral buttress region of the lumbar pars interarticularis from L1–L5 on 10 dried lumbar spines was performed.Objective.To qualitatively describe and quantitatively evaluate this portion of the pars and to discuss its clinical and surgical relevance.Background.The “lateral buttress” is a bony bridge connecting the superolateral edge of the inferior facet to the pedicle/transverse process junction, offering structural support to the pars interarticularis at upper lumbar levels. To date, no anatomic study has evaluated this structure.Methods.Direct measurements using vernier calipers were taken at each level, L1–L5, from 10 dried lumbar spines. Surface area of the buttress was calculated and compared statistically for differences between each level, as well as normalized relative to L3.Results.The surface areas of the buttresses at L1–L3 were similar, measuring near 80 ± 10 mm2. At L4, it measured 50 ± 10 mm2. And at L5, it measured 15 ± 5 mm2. These differences were statistically significant. Normalized data showed the buttress at L4 to be 40% smaller and at L5 to be 80% smaller than at upper levels.Conclusions.This study provides descriptive and anatomic data regarding the lateral buttress portion of lumbar pars interarticularis. The broad buttress of the upper lumbar levels offers support to the pars but can confuse anatomic guidelines for pedicle screw placement and paraspinal approaches. The narrow buttress of lower lumbar levels makes pedicle screw placement and the paraspinal approach easier, but it lessens support to the pars, making spondylolysis and iatrogenic instability more likely.Spine 2002;27:E385–E387

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A systematic review.Objectives.This systematic review sought papers (January 1989–January 2000) on the passive straight leg raising test (PSLR) as a diagnostic component for low back pain (LBP) to identify, summarize, and assess developments in the test procedure, the factors influencing PSLR outcome, and the clinical significance of that outcome.Summary of Background Data.Previous studies suggested that the PSLR tractioned the sciatic nerve and that diminished leg elevation with reproduced pain indicated low lumbar intervertebral disc pathology.Methods.Searches on six computerized bibliographic databases identified publications written about the PSLR. Papers were excluded if they were published before January 1989, were non-English language papers, or employed either an active SLR or a PSLR for purposes other than LBP diagnosis. The references of qualifying papers (and the references of references) were searched. Contact with primary authors, and others known to be active in this field, was attempted.Results.The PSLR procedure remains unchanged. The influence of hip rotation during the PSLR was discussed without consensus. Biomechanical devices improved intra- and interobserver reliability and so increased test reproducibility. Hamstrings were found to have a defensive role in protecting nerve roots by limiting PSLR range in cases of nerve root inflammation. A small diurnal variation in the PSLR may imply a poorer prognosis. A positive PSLR at 4 months after lumbar intervertebral disc surgery predicted poor reoperative outcome, and a negative 4-month PSLR predicted excellent outcome. The influence of psychosocial factors was not discussed, neither was the diagnostic significance of a negative PSLR outcome.Conclusions.There remains no standard PSLR procedure, no consensus on interpretation of results, and little recognition that a negative PSLR test outcome may be of greater diagnostic value than a positive one. The causal link between LBP pathology and hamstring action remains unclear. There is a need for research into the clinical use of the PSLR; its intra- and interobserver reliability; the influences of age, gender, diurnal variation, and psychosocial factors; and its predictive value in lumbar intervertebral disc surgery.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case of acute low back pain caused by pseudogout attack of the lumbar facet joint is reported.Objective.To report a new cause of acute low back pain previously unreported in the literature.Summary of Background Data.There have been some reports of lumbar spinal stenosis caused by calcium pyrophosphate dihydrate crystal deposition. However, there are no known reports of pseudogout attack of the lumbar facet joint.Methods.An axial magnetic resonance imaging scan demonstrated joint effusion at the level of the bilateral L4–L5 facet joint. Aspiration of the left L4–L5 facet joint yielded 1.5 mL of pus-like synovial effusion. Multiple cultures of synovial fluid tested negative for bacteria and fungi, whereas compensated polarized light microscopy revealed monoclinic or triclinic crystals with a positive birefringence.Results.The symptoms of acute low back pain lasted for 3 days. Local and systemic inflammatory signs, as well as symptoms, gradually improved after joint aspiration. A follow-up evaluation 8 months after lumbar facet joint aspiration showed complete resolution of pain and no neurologic deficit.Conclusions.Pseudogout attack of the lumbar facet joint is rare, but this clinical entity should be added to the differential diagnosis of acute low back pain.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A case of intraoperative anterior migration into the abdominal cavity of a titanium fusion cage in the course of posterior lumbar interbody fusion.Objectives.To explain the importance of a proper introduction of the fusion cages in the vertebral space and the necessity of intraoperative fluoroscopy study in both planes, frontal and lateral, respectively, to confirm the proper position of the implants. A potential serious complication of fusion cage instrumentation and the limited literature on this subject are reviewed.Summary of Background Data.Early reports regarding fusion cage instrumentation have been encouraging. However, the potential benefits are better defined than the potential complications.Methods.A patient had anterior migration of a fusion cage intraoperatively in the course of posterior lumbar interbody fusion. One day later, the patient underwent surgical laparotomy to extract the migrated implant and a repeat posterior procedure that included bilateral posterior fusion with insertion of pedicle instrumentation.Results.One year after the second operation, the patient remains pain-free, and no abdominal lesions or neurologic deficits were observed.Conclusions.The various types of spinal fusion operations are associated with specific complications. A through knowledge of the procedures and possible complications, as well as meticulous surgical technique, can help minimize these. Once complications do occur, prompt recognition and treatment should minimize the long-term sequelae.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain.Objective.To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function.Summary of Background Data.Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals.Methods.For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discreetly recorded by a “blinded” researcher. Primary outcomes were knowledge, attitude, behavior, and function.Results.In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P= 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P= 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested.Conclusions.This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A randomized controlled trial with a 6-month follow-up period was conducted.Objective.To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain.Summary of Background Data.Chronic lower back pain involves muscular as well as connective and neural systems. Different types of physiotherapy are applied for its treatment. Industrial vibration is regarded as a risk factor. Recently, vibration exercise has been developed as a new type of physiotherapy. It is thought to activate musclesviareflexes.Methods.In this study, 60 patients with chronic lower back pain devoid of “specific” spine diseases, who had a mean age of 51.7 years and a pain history of 13.1 years, practiced either isodynamic lumbar extension or vibration exercise for 3 months. Outcome measures were lumbar extension torque, pain sensation (visual analog scale), and pain-related disability (pain disability index).Results.A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups. Lumbar extension torque increased significantly in the vibration exercise group (30.1 Nm/kg), but significantly more in the lumbar extension group (+59.2 Nm/kg; SEM 10.2;P< 0.05). No correlation was found between gain in lumbar torque and pain relief or pain-related disability (P> 0.2).Conclusions.The current data indicate that poor lumbar muscle force probably is not the exclusive cause of chronic lower back pain. Different types of exercise therapy tend to yield comparable results. Interestingly, well-controlled vibration may be the cure rather than the cause of lower back pain.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months.Objectives.To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group.Summary of Background Data.Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache.Methods.In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture.Results.There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P< 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant.Conclusion.Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Study Design.A randomized controlled trial in occupational health practice was conducted.Objective.To study the efficacy of early management of workers with low back pain by occupational physicians, as compared with management by the supervisor only.Summary of Background data.Health care and university workers with back pain and on sick leave for less than 1 month were included in the study.Methods.Patients with low back pain for at least 10 days on sick leave were randomly assigned to early management by the occupational physician (n = 61) or to a reference group with management by the worker’s supervisor during the first 3 months of sick leave (n = 59). The patients were observed for 1 year and compared in terms of time until return to work, pain intensity, functional disability, and general health perception. The occupational physicians were provided with management guidelines.Results.No significant differences were found after 3 and 12 months of follow-up evaluation in terms of time until return to work (hazard ratio, 1.3; 95% CI, 0.90–1.90) or in terms of other health outcomes. Recurrences, however, occurred more frequently in the intervention group, but the total duration of sick leave in 1 year did not differ between the groups.Conclusions.The findings do not show a significant positive effect of an early intervention by occupational physicians on workers with low back pain. This might reflect the early phase of disability or the low intensity of the intervention resulting from overestimation of the physicians’ compliance with the guidelines.

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:2002

数据来源: OVID