摘要:

A longitudinal, prospective study was conducted on 3,020 aircraft employees to identify risk factors for reporting acute back pain at work. The premorbid data included individual physical, psychosocial, and workplace factors. During slightly more than 4 years of follow-up, 279 subjects reported back problems. Other than a history of current or recent back problems, the factors found to be most predictive of subsequent reports in a multivariate model were work perceptions and certain psychosocial responses identified on the Minnesota Multiphasic Personality Inventory (MMPI). Subjects who stated that they “hardly ever” enjoyed their job tasks were 2.5 times more likely to report a back injury (P= 0.0001) than subjects who “almost always” enjoyed their job tasks. The quintile of subjects scoring highest on Scale-3 (Hy) of the MMPI were 2.0 times more likely to report a back injury (P= 0.0001) than subjects with the lowest scores. The multivariate model, including job task enjoyment, MMPI Scale-3, and history of back treatment, revealed that subjects in the highest risk group had 3.3 times the number of reports in the lowest risk group. These findings emphasize the importance of adopting a broader approach to the multifaceted problem of back complaints in industry and help explain why past prevention efforts focusing on purely physical factors have been unsuccessful.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The inability to predict outcome in patients with low-back pain seriously impedes clinical trials and leads to inappropriate or unnecessary treatment. This prospective study investigated the value of multivariable mathematical models to predict the 1-year clinical course of 109 patients with low-back trouble (LBT). Discriminant analysis was used to determine predictive models for outcome groups at 1 month, 3 months and 1 year. The variables selected in the analyses were subsets of 29 items from a clinical interview at presentation. These included anamnestic features of the first episode as well as symptomatic details and results from clinical tests for the current spell. The derived models successfully discriminated outcome groups with estimates of sensitivity and specificity ranging from 63 to 99%. When models from one set of patients were tested for predictive accuracy by the application of them to a different set, nonrecovery and satisfactory improvement were predicted with a 76–100% success rate. The results affirmed the importance of considering combinations of interrelated variables for prediction and discrimination in LBT. This work has demonstrated that outcome can be predicted successfully by the use of mathematic models based just on presentation data. The ability to determine homogenous groups in respect to outcome is seen as an important aid to therapeutic research; further work will enable refinement of these models for general clinical use and for incorporation into computer-based interview systems.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A review of related literature and trends was used to develop a protocol for testing range of motion, isometric strength, velocity, endurance, and consistency of effort in the low-back pain (LBP) population by the use of the triaxial, Isostation B-200 Lumbar Dynamometer. Eightyfive men and 83 women with no history of LBP for the past 6 months volunteered for the study. Relationships between demographic and test measures were calculated by the use of the Pearsonrcorrelation analysis and ANOVA. Body weight, age, and gender all showed strong (P< .001), positive relationships to various test measures. The normative database is reported in terms of descriptive statistics allowing comparison of future test results within the normal distribution and corrected for significant demographic features.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A series of experiments were performed on eight whole, cadaveric lumbar spines and on eight male volunteers to determine whether axial rotation changed with subjects bending forward compared with being in a neutral posture and whether rotation was affected by articular tropism. Kirschner wires were inserted into the spinous processes of the eight cadaveric lumbar spines, and the axial rotation of the wires was measured while the spine was rotated in a torsion apparatus. Similarly, Steinmann pins were inserted into the spinous processes of L3, L4, and L5 of the eight volunteers, and the axial rotation of the pins was measured while the subjects rotated in a torsion apparatus. Axial rotation was found to be less when combined with forward flexion, and articular tropism did not influence the amplitude of rotation.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The use of flexicurves to measure lumbar sagittal mobility was subjected to a series of reliability and validation experiments. Appropriate statistical methods were described and used to quantify intraobserver and intrasubject variability and to determine limits of agreement with measurements from radiographs. It was shown that the traditional use of correlation coefficients can produce misleading or inadequate information. The flexicurve technique had an intraobserver variability of 3–4° of movement, was not significantly influenced by intrasubject variability, and provided measurements typically within 6° of radiographic measurements. The data suggest that the flexicurve technique is less biased than the inclinometric method. These results demonstrate the use of suitable statistical methods to assess the clinical usefulness, or level of interchangeability, of spinal measurement instruments.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Impingement of plical synovial tissue in a facet joint could cause pain. Plical tissue was removed during surgery for recurrent disc herniation or spinal stenosis. The presence of nerves was studied with silver impregnation, immunofluorescence, and avidin-biotin-peroxidase complex (ABC) immunostaining. Heterologous antisera to protein gene product (PGP) 9.5, substance P, calcitonin gene-related peptide (CGRP), and galanin were used to stain nerves. After silver impregnation, nerve-like structures were observed perivascularly. Such nerves located close to blood vessels were also immunoreactive for PGP 9.5, a more general cytoplasmic neural marker, whereas only few perivascular small varicosities were seen with antisera to substance P and galanin and none with antiserum to CGRP. In addition, PGP-9.5-, substance-P-, and galanin-immunoreactive nerves were occasionally seen very near to fat globules. Very few peptide-immunoreactive nerve varicosities were seen with immunofluorescence, and none of the PGP-9.5-immunoreactive nerves that were observed with ABC immunostaining were immunoreactive for neuropeptides as well. One mechanism for pain production could be mechanical compression of fatty tissue, but it is considered more likely that nerves in this particular tissue are mainly involved in local vasoregulation and that they are not sensory nociceptive nerves.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Fifteen cadaveric dissections have been performed to determine the anatomic relationships of nucleotomy guide wires. All the 44 guide wires inserted were found to be in contact with at least one nerve root (eight transfixed a root). Guide wires passing anterior to the nerve roots always passed anterior to the center of the disc. Lateral displacement of the skin entry point made safe entry to the center of the disc impossible. Nerve root transfixion is likely to be a significant complication in percutaneous nucleotomy. Entry to the center of the disc avoiding the nerve roots is simplest if the skin entry is as near to the midline as possible.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The enzyme chondroitinase ABC has recently been suggested for use in chemonucleolysis. The effects of 200 U/ml of chondroitinase ABC were studied on intrathecal and peripheral nerve tissue in rabbits. After the intrathecal (subarachnoid) application of 0.2 ml of either the diluent in the control group (N = 2) or chondroitinase in the study group (N = 4), no neurologic deficit was detected. Compared with the control group, no morphologic changes at the light microscopic level were induced in the spinal cord by chondroitinase. No neurophysiologic differences were detected between tibial nerves after exposure to 1 ml of the diluent (control, N = 8) or chondroitinase (the other leg) for 4 weeks, nor did the study group, compared with the control group, show any morphologic changes in the tibial nerves. Because the concentration of chondroitinase ABC tested was approximately 40 times higher than might be used clinically for chemonucleolysis, the present study indicates a wide margin of safety for unwanted side effects on nerve tissue.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A retrospective study of 84 patients with Paget's disease of the spine revealed 9 who developed pagetic intradiscal invasion from the adjacent vertebral bodies. Two patients were asymptomatic. One patient had back pain, one had symptomatic intraforaminal stenosis without back pain, and five had clinical and radiologic spinal stenosis and spine pain; of these five, one demonstrated clinical and radiologic findings indistinguishable from spondylodiscitis. The incidence of intradiscal transgression in Paget's disease of the spine was 10.7%. Spinal pain was present in 67% patients; 22% were asymptomatic. This study shows that disc pathology is not invariably associated with spinal pain.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cerebrospinal fluid (CSF) leakage from a postoperative wound after lumbar spine operation is an uncommon complication. It may result from excessive traction of the nerve roots, direct trauma, or laceration at the time of operation, causing the dura to be inadvertently opened.1,4Other reasons for this complication are postlaminectomy residual bone spikes, traumatic myelography puncture,2and improper suture of dura defects. Eight patients who had postoperative CSF leakage as the only complication after lumbosacral spine operations were examined. They were all treated conservatively with bed rest in the Trendelenburg position, antibiotic coverage, watertight skin suturing, and daily subcutaneous punctures. No patient was operated on for the same type of complication.

ISSN:0362-2436    

出版商:OVID    

年代:1991

数据来源: OVID