摘要:

A meta-analysis was undertaken to determine the effects of surgery for lumbar spinal stenosis on pain and disability. Seventy-four journal articles met inclusion criteria and were independently reviewed by two readers. On average, 64% of patients treated surgically for lumbar spinal stenosis were reported to have good-to-excellent outcomes. However, there was wide variation across studies in the percentage with good outcomes. Few patient characteristics were found to predict outcome. Major deficits in study design, analysis, and reporting were common, and these precluded firm conclusions.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The pathophysiology of neurogenic claudication is not well understood. It is generally believed that stenosis of the central vertebral canal is significant, but some believe that it is root canal stenosis or stenosis of the foramen that is important, not pathology in the central canal. There are, however, clinical anomalies incompatible with either view. In this article, 49 patients with neurogenic claudication were examined with myelography and computed tomography, recording the frequency of multilevel central canal stenosis and the presence of coexistent root canal stenosis. Of the 49 patients, 46 had either multilevel central canal stenosis or stenosis of both central and root canals. It was concluded that neurogenic claudication is generally associated with at least two levels of stenosis. A hypothesis of two-level venous compression, with venous pooling of one or several nerve roots, explains some of the pathophysiology of neurogenic claudication. This hypothesis is compatible with clinical and experimental observations, but it has yet to be confirmed.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To determine the influence of the duration of postoperative lumbar immobilization with the aid of a rigid lumbar orthosis on the consolidation of posterolateral lumbosacral fusions, 22 patients with no previous osseous spinal surgery and with fusion without osteosynthesis due to spondylolysis-olisthesis Grade 1 to 2 or intervertebral disc or facet joint disorder were examined by roentgen stereophotogrammetric analysis in supine and erect positions and by conventional radiography for 1 year after surgery. In Series 1, patients (n = 11) were instructed to keep the trunk straight with the aid of a molded, rigid lumbar orthosis for 5 months after surgery; and in Series 2 (n = 1), the same instructions were given, but for 3 months. In Series 1, osseous fusion was seen on radiographs in eight patients. In these patients, the intervertebral translations between the fused vertebrae began to decrease 3–6 months after surgery, and within 1 year, the fusions became rigid, as defined by roentgen stereophotogrammetric analysis, or intervertebral translations of mostly less than 1 mm persisted. In three patients with poor fusion still seen on radiographs 1 year after surgery, no rigid fusion was obtained and intervertebral translations of up to 10 mm persisted. In Series 2, a similar roentgen stereophotogrammetric analysis pattern was noted in two patients with osseous fusion and in seven with poor fusion seen on radiographs. The fusion was radiographically doubtful in two patients. In these patients, the intervertebral translations decreased, but translations of 1.5 mm persisted 1 year after surgery. The rate of fusion healing according to roentgen stereophotogrammetric analysis or radiography was significantly higher (P< 0.05, Fisher exact test) in Series 1 than in Series 2. This seems consistent with the roentgen stereophotogrammetric analysis finding of rather late onset (3–6 months after surgery) of decreasing translatory mobility between the fused vertebrae in successful fusions. The study illustrates the value of roentgen stereophotogrammetric analysis in prospective comparative studies of spinal disorders.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To define the cost-effectiveness of a back school program in industry, a controlled longitudinal field study was carried out in a Dutch bus company. The experimental group received a program consisting of information on back care, physical fitness, nutrition, stress, and relaxation. Objective data on absenteeism were collected and compared during a 6-year period for the control and experimental groups. Results showed that a tailor-made back school program reduced absenteeism by at least 5 days per year per employee, therefore being cost-effective to industry. A reduction was not observed in incidence, but in mean length of absenteeism. This effect turned out to be persistent during a 2-year period following the program.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In a randomized trial, the effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for patients (n = 256) with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner. Differences in effectiveness between physiotherapy and manual therapy could not be shown. A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The Low-Back Outcome Score has been devised as a new and accurate rating system for patients with low-back pain. Thirteen factors, such as pain, employment, sporting ability, rest required, and activities of daily living, were included; subjective opinion was excluded. Pain and active pursuits were weighted. Presentation of the score as a questionnaire, excluding examination findings, eliminated both interobserver variation and observer variation with time. The score was applied retrospectively in a follow-up study of conservatively treated patients and was found to be more comprehensive and more discriminating than the Oswestry Disability Score, the Waddell Disability Rating, or the Waddell Physical impairment Rating. The Low-Back Outcome Score is recommended for further evaluation in future prospective studies in low-back pain.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The integration of physical and psychological assessment is frequently problematic. Psychological tests are often cumbersome and difficult to interpret. There would appear to be a need for a simple assessment method that would identify distress and help alert the clinician to the need for a more comprehensive assessment. The Distress and Risk Assessment Method is derived from a simple set of scales validated for use with patients with low-back pain. It offers a simple classification of patients into those showing no psychological distress, those at risk of developing major psychological overlay, and those clearly distressed. Four patient types can be identified on the basis of scores on two short questionnaires. The construction of the Distress and Risk Assessment Method is described and validity data (both clinical and psychological) are presented. The use of the Distress and Risk Assessment Method in the prediction of outcome of treatment is presented, and the paper concludes with general guidelines for its use.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To determine the prevalence of back pain and its development over the first postpartum period, 817 women who had been followed through pregnancy were studied a minimum of 12 months after delivery. More than 67% of the women experienced back pain directly after delivery, whereas 37% said they had back pain at the follow-up examination. Most of the women who had recovered became pain-free within 6 months. Factors that correlated to persistent postpartum back pain were the presence of back pain before pregnancy, the presence of back pain during pregnancy, physically heavy work, and multipregnancy. Of these four factors, physically heavy work was found to have the strongest association with persistent back pain at 12 months.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Thirty patients with persistent sciatica due to a single disc protrusion were injected with 0.5 ml (2.0 mg) or 2.0 ml (8.0 mg) of chymopapain. Serial 24-hour urine samples were collected 1 day preinjection and for 5 days postinjection for glycosaminoglycan analysis. There was a significant increase in urinary glycosaminoglycan in both groups following chemonucleolysis, but no significant difference was found between the two groups in the total excretion of glycosaminoglycan during the 5-day period. Low-dose, low-volume chemonucleolysis may be as effective as standard doses in releasing glycosaminoglycan from intervertebral discs.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To study the long-term health effect of whole-body vibration, a questionnaire on symptoms of ill health was mailed to 242 drivers and a reference group of 210 workers from six harbor companies (response 81%). Vehicles driven were fork-lift trucks and freight-container tractors. Vibration level during a representative working period (vector sum of the frequency weighted acceleration in the x-, y-, and z-directions) was 0.8 m/sec2for the fork-lift trucks and 1.0 m/sec2for the freight-container tractors. Only the results concerning self-reported symptoms of the back are described. Of the young (

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID