Spine
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Fifty-one consecutive patients who underwent extradural sensory rhizotomy for chronic radiculopathy after lumbar surgery were reviewed retrospectively. ⋯ The results of the rhizotomy procedures deteriorated over time. Possible reasons for the failure, other than temporal deterioration, were anatomic factors and lack of specificity of diagnostic techniques, specifically selective nerve root sheath injection. At this point rhizotomy cannot be recommended with any confidence whatsoever in the setting of chronic lumbar radiculopathy after lumbar surgery.
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The effect of intraoperative hip position on maintenance of lumbar lordosis was evaluated radiographically in 13 anesthetized patients and 14 unanesthetized volunteers positioned on a Wilson frame (MDT Corp., Torrance, CA). ⋯ Hip flexion was associated with a significant decrease in lordosis in patients and volunteers. Positioning in maximal hip extension optimizes lordosis preservation. While other devices have been shown to have specific effects on lordosis, the Wilson frame can permit easy adjustment of the lumbar sagittal contour to facilitate either preservation or reduction in lordosis.
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Comparative Study
Community studies of the health service implications of low back pain.
Retrospective study using primary care physician case notes and a self-report questionnaire on the same randomly selected population sample. ⋯ Prevalence rates were comparable with those reported in other studies. The significant discrepancies between data sources suggest patient recall bias or underrecording in case notes. The low consultation rate, time off, and day-to-day disability indicate that most episodes are self-limiting.
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A systematic review of randomized controlled trials. ⋯ The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.
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Back and neck pain was studied cross-sectionally in 1,449 urban transit drivers by linking medical data, self-reported ergonomic factors, and company records on job history. ⋯ The results support the hypothesis of a causal role of physical workload for the development of back and neck pain. Ergonomic factors partially mediated the risk of back and neck pain associated with driving, suggesting a potential for prevention of back and neck pain by ergonomic redesign of transit vehicles. Elevated risks for back and neck pain for female drivers were not explained by anthropometric and ergonomic factors.