Spine
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One hundred eight patients from a consecutive series of 125 anterior lumbar interbody fusions were invited to take part in a clinical outcome assessment (including plain radiography and magnetic resonance imaging of the lumbosacral spine) more than 10 years after the original surgery. ⋯ The findings of the study suggest that the assessment of outcome of lumbar interbody fusion is strongly compounded by the psychological make-up of the patient and that this effect is maintained in the long term. However, the negative effect of compensation observed at 2 years seems to dissipate with time and becomes insignificant at 10 years.
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This investigation had two components: one was an item analysis that examined data obtained at the initial patient assessment, and the second was a validation study that used a pretest-posttest design. ⋯ The RM-18 can be used as an outcome measure in clinical trials or as a tool to aid in decision making concerning individual patients. In either case, its measurement properties are equal to those of the 24-item Roland-Morris Questionnaire.
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Prevalence rates of childhood abuse, socioeconomic outcome data, and levels of psychopathology were evaluated for graduates of a functional restoration program for chronically disabled spinal disorder patients in a workers' compensation environment. ⋯ These results demonstrate that although a history of childhood abuse is associated with greater psychosocial disturbances in chronically disabled spinal disorder patients, such disturbances do not interfere with an initial positive response to an effective tertiary rehabilitation program such as functional restoration. However, a history of childhood abuse may be related to poorer socioeconomic outcomes after discharge from rehabilitation programs. Additional treatment options may be needed for these patients.
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A retrospective review of transpedicular instrumentation used in a series of 24 patients with myelodysplastic spinal deformities and deficient posterior elements. ⋯ Pedicle screw instrumentation is uniquely suited to the deficient myelodysplastic spine. Compared with historical control subjects, these devices have proven capable of significant correction of both scoliotic and kyphotic deformities. This instrumentation appears particularly useful in preserving lumbar lordosis in all patients and may preserve more lumbar motion in ambulatory myelodysplasia patients.
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The authors investigated the innervation of discographically confirmed degenerated and "painful" human intervertebral discs. ⋯ Findings indicate a more extensive disc innervation in the severely degenerated human lumbar disc compared with normal discs. The nociceptive properties of at least some of these nerves are highly suggested by their substance P immunoreactivity, which provides further evidence for the existence of a morphologic substrate of discogenic pain.