摘要:

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Several anthropometric measurements were studied for their prediction of scoliosis in 896 children (430 girls and 466 boys) who were free from scoliosis at entry. The children were examined annually from the average age of 10.8 to 13.8 years to follow up their trunk asymmetry, posture, and growth. Scoliosis developed in 24 boys and 41 girls (Cobb angle >10° in a posteroanterior standing radiograph) during the 3 years. In both girls and boys, trunk asymmetry measured by the forward bending test was found to be the most powerful determinant of the incidence of scoliosis. In the whole cohort the adjusted odds ratio was 1.61 and its 95% confidence interval was 1.42-1.82 per one millimeter increase in trunk hump. Using spinal pantography the degree of thoracic kyphosis in girls (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, per one degree) and the degree of lumbar lordosis in boys (odds ratio = 1.07,95% confidence interval = 1.01-1.13, per one degree) were significant predictors of future scoliosis. In the children both sexes who eventually had scoliosis, body height, sitting height, and growth of sitting height were greater than in other children, but these factors carried no statistical significance in the logistic analyses. There were differences between the prescoliotic girls and other girls in both mean age (11.8 vs 12.1 years, P = 0.02) and value (5.5 cm vs 6.1 cm/yr, P = 0.08) of peak sitting height velocity. The authors conclude that a number of characteristics related to trunk asymmetry, posture and growth, independently of one another predict the development of manifest scoliosis in prepubertal children

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Skeletal maturity in 86 girls with adolescent idiopathic scoliosis was determined by assessing their bone age at the hand and wrist and by the development of their iliac (Risser's sign) and ischial apophyses.The two methods were compared and a statistically significant correlation was noted, signifying that the development of the iliac and ischial apophyses is a sensitive parameter for assessing skeletal maturity in these patients.The iliac apophysis is visible on routine follow-up radiographs of these patients, so using this criterion results in a reduction of roentgen ray exposure to the patient and significant financial savings. A more sensitive method of assessing the development of the iliac and ischial apophyses is suggested.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The standing heights of 40 children with scoliosis and 110 persons from their immediate families were compared with those of a group of 349 contemporary control subjects. Skeletal bone ages and puberty ratings did not differ from normal, but the children with scoliosis were found to be significantly taller than the controls. They were also taller than their unaffected relatives, suggesting that the increased stature is not due to genetic factors alone. Scoliotic children with an affected immediate-family member were of normal height, which suggests that growth is of less etiological importance in children with a strong genetic susceptibility.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Sixty patients with single-level lumbar disc herniation confirmed by computerized tomography were studied in a randomized prospective study. The aim was to see if there was any difference between the microscopic removal of a disc herniation and the standard procedure. All patients were operated on by the same surgeon by either method. They were all followed up by an impartial observer at 3 weeks, 2 months, 6 months, and 1 year. There were no differences between the groups regarding perioperative bleeding, complications, inpatient stay, time off work, or end result. The authors concluded that the decision to use the operating microscope may be left to the surgeon, because it had no effect on the short-term results or those at 1 year.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Postoperative low-back pain and spasm are the main drawbacks of chymopapain chemonucleolysis. To investigate if low-dose chymopapain could reduce this adverse reaction, without modifying the efficacy, 118 patients with persistent low-back and radicular pain due to a lumbar disc herniation underwent chemonucleolysis. 60 patients were randomly selected to receive 2 mL of standard-dose chymopapain (4,000 units) and 58 to receive 2 mL of low dose (2,000 units). The clinical outcome was assessed on study days 1, 30, and 60, and after 1 year by physicians who were unaware of the treatment, and on the basis of the patients' self evaluation. At day 60, Chemonucleolysis was rated as successful in 81% of the cases by the investigator and in 80% by the patient's self assessment. The percentage of good results was remarkably similar in the two treatment groups and this finding was confirmed after 1 year. There was some evidence that the low-dose treatment resulted in less frequent postoperative back pain but the difference was not statistically significant. Moreover, a comparable incidence of acute low-back pain and spasm was observed in the two treatment groups. Low-dose chemonucleolysis appears to be as effective as the standard dose, but the use of 2,000 units does not significantly lower the postoperative back pain.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Recently smoking has been increasingly implicated as a possible risk factor for low-back pain. One explanation for this finding is confounding by occupation. To investigate this possibility, the relationship between smoking and self-reported back pain was studied within 13 occupations. A relationship between smoking and back pain was observed only in occupations that require physical exertion. The relationship between smoking and other musculoskeletal pain also was explored. Pain in the extremities turned out to be related more clearly to smoking than to pain in the neck or the back. This suggests confounding or a general influence of smoking on pain. It is concluded that prevention of back pain could be a beneficial side-effect of anti-smoking campaigns. However, the prime target for prevention of low-back pain would have to be other factors.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patient pain drawings were blindly selected from five lumbar spine disorder categories. The drawings were classified by low-back physicians, discriminant analysis, and several computerized artificial neural network configurations. The purpose was to determine the reliability of the patient pain drawing when diagnosing low-back disorders and to delineate the pain mark patterns particular to each disorder by comparing physicians with computerized methods. The physicians averaged 51% accuracy with individual preferences for certain disorder groups. The computerized methods demonstrated comparable accuracy (48%) and more agreement in classification. Associations were found between the predicted pain patterns for each diagnostic group made by an expert and the patterns generated by computerized methods. Variances in these associations are instructive to clinicians for making accurate predictions of diagnosis from pain drawings.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A 1-year longitudinal study was performed to assess and compare the predictive qualities of spinal health indicators (excluding the cervical spine) among aircraft assembly workers having at least 1 year seniority in a large assembly plant. Ten health indicators were compared to determine their sensitivity and predictive power with regard to back compensation and absenteeism in 12 months follow-up, and the presence of any limitation at work due to the back, or symptoms to the back at the end of the interval. The initial response to a self-administered questionnaire was obtained from 269 male workers, of whom 205 (76.2%) completed the follow-up questionnaire. Initial prevalence of symptoms to the back was 42.3%, limitation in performing at work was 28.1%, consultation of a health professional was 7.3%, and a history of compensation for the back (ever) was reported by 30.4%. During the year of follow-up, 16 (6%) of the 269 workers initially enrolled were granted 17 compensated episodes. Of the 205 workers who responded to the follow-up, 33 (16.1%) have been absent from work (with or without compensation) because of their back. The presence, at the beginning of the study, of a limitation in performing at work or in activities of daily living and a history of compensation (ever) were the three indicators independently associated with the occurrence of compensation or absenteeism (total work disability) related to a back problem during the following year. The three indicators combined (either one positive at beginning of the study) had a sensitivity rate of 81.8% and a predictive power rate of 28.4% (predicting total work disability). These results are the best ever published for a spinal health indicator measured from a survey questionnaire. Besides acceptable predictive qualities, the combined indicator predicted work disability from predisability states. Its value for targeting interventions in industry aimed at preventing the worsening of early stages of spinal disorders toward disabling conditions, remains to be tested.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Several biomechanical factors were recorded intermittently in 855 pregnant women from the 12th to the 36th week of gestation and were related to back pain occurrence during pregnancy. The three factors related to the development of back pain were abdominal sagittal diameter, which correlated with back pain, with a coefficient of 0.15 [P< 0.01); transverse diameter (r=0.13, P< 0.01); and depth of the lumbar lordosis, which correlated with a coefficient of 0.11 (P< 0.01). In the group of women who were pregnant for their first time, there was a significantly lower peripheral joint laxity in the 12th week in those women who, later in pregnancy, developed back pain. These correlations suggest that back pain in pregnancy can not be explained primarily by biomechanical factors.

ISSN:0362-2436    

出版商:OVID    

年代:1993

数据来源: OVID