Spine
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Clinicians and researchers increasingly recognize the importance of the patient's perspective in the evaluations of the effectiveness of treatment. The rapid growth in the number and types of patient-based outcome measures can be confusing. This supplement provides a state-of-the-art review of the available tools. ⋯ For those who are still at work, new measures are being developed to measure health-related work limitations. No single measure of patient satisfaction is clearly preferred but guiding principles are provided to choose among available measures. In addition to the five recommended domains, preference-based health outcome measures, including patients utilities, may be useful when there is a need to value alternative health outcomes.
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This study tested the hypothesis that the 17-kDa form of tumor necrosis factor-alpha is the pathophysiologic agent expressed by herniated nucleus pulposus in vivo that is primarily responsible for the histologic and behavioral manifestations of experimental sciatica associated with herniated lumbar discs. ⋯ The data reinforce other evidence that tumor necrosis factor-alpha is involved in mechanisms of neuropathic pain.
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Randomized Controlled Trial Clinical Trial
Provocative discography in patients after limited lumbar discectomy: A controlled, randomized study of pain response in symptomatic and asymptomatic subjects.
This was a prospective observational study of patients with low back pain and those without after laminotomy and discectomy. ⋯ A high percentage of asymptomatic patients with normal psychometric testing who previously have undergone lumbar discectomy will have significant pain on injection of their discs that had previous surgery (40%). This is not significantly different from the experience of symptomatic patients with normal psychometric testing undergoing discography on discs that had previous surgery. Patients with abnormal psychological profiles have significantly higher rates of positive disc injections than either asymptomatic volunteers or symptomatic subjects with normal psychological screening.