Spine
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Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Despite advances in diagnosis and surgical treatment, many patients still have severe permanent neurologic deficits caused by this condition. An improved understanding of the pathophysiology of cervical spondylotic myelopathy, particularly at a cellular and molecular level, may allow improved treatments in the future. ⋯ Free radical-and cation-mediated cell injury, glutamatergic toxicity, and apoptosis may be of relevance to the pathophysiology of cervical spondylotic myelopathy. To date, research in cervical spondylotic myelopathy has focused exclusively on the role of mechanical factors and ischemia. Fundamental research at a cellular and molecular level, particularly in the areas of glutamatergic toxicity and apoptosis may result in clinically relevant treatments for this condition.
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An experimental study to elucidate the initial factors in the pathogenesis of lumbar pain caused by disc herniation. ⋯ Application of nucleus pulposus to nerve root increased endoneurial fluid pressure and decreased blood flow in the dorsal root ganglia. This study's acute observations in the dorsal root ganglia may thus help to explain why disc herniations without compression of neural tissue are sometimes painful because similar pathologic findings are observed after only nucleus pulposus application to the nerve root. The authors further suggest that exposure of nerve roots to nucleus pulposus may establish a "compartment syndrome" in the dorsal root ganglia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Opioid therapy for chronic noncancer back pain. A randomized prospective study.
A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain. ⋯ The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.
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The effects of human trunk extensor muscle fatigue on the estimated trunk muscle forces and spinal loading were investigated during the performance of repetitive dynamic trunk extension. ⋯ The results of the study do not suggest that an increase in the muscular loading of the spine occurs as a result of changing trunk muscular recruitment patterns. Therefore, future studies should focus on injury mechanisms that may occur as a result of a change in the viscoelastic passive tissue responses, muscular insufficiency, or a decline in neuromuscular control and coordination.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.
Randomized, controlled trial. ⋯ Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.