Spine
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The authors studied the rotational effect of sublaminar wiring on the spinal pelvic axis on 20 patients who were being treated for adolescent idiopathic scoliosis. ⋯ Coronal and sagittal plane correction of scoliotic curves may be achieved with sublaminar instrumentation. The ability to derotate axially the scoliotic spine appears to be variable, however, and, in most cases, curve-type dependent. Over time, much correction appears to be lost, and in many patients the scoliosis actually becomes worse than it was before surgery. Nonetheless, the apical derotation that takes place appears to be reasonably true: the percent correction of angle of rotation about the sagittal plane and the percent correction of angle of rotation about the sagittal plain relative to the pelvis were closely correlated. Derotation forces applied to the instrumented spine do not appear to be transmitted to more distal segments.
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A prospective, functional assessment based on physical ability and independence in daily activities was performed of patients who had severe physical handicaps and spinal deformities and were undergoing scoliosis surgery. ⋯ Corrective spinal surgery in patients with severe physical handicap should be performed early to preserve function and should not be dictated solely by the severity of the curvature. Improvement in the patient's level of independence may not necessarily occur after truncal stabilization. Cosmetic results in these patients with severe disabilities were extremely gratifying to the patients and their caregivers.
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Criteria-based review. ⋯ In acute back pain, exercise therapy is ineffective, whereas in subacute back pain, exercises with a graded activity program, and in chronic back pain, intensive exercising, deserve attention. More research on McKenzie therapy, on exercises with a graded activity program, and on different types of exercising in patients with chronic back pain is necessary.
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Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. ⋯ Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.
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A brief review of current literature and issues on drug therapy for low back pain. ⋯ It seems reasonable to recommend acetaminophen or nonsteroidal anti-inflammatory drugs for patients with acute back pain, with efforts to minimize costs and complications. Muscle relaxants and narcotic analgesics may be appropriate for some patients, but selection criteria are unclear, and these drugs should be prescribed for fixed periods. Drug treatment for chronic low back pain is less clear, and a current controversy centers on the use of chronic narcotic analgesics for such patients. Future research should include evaluating combinations of medications, combinations of medication and physical therapy, systemic corticosteroid therapy, trigger point injections, and narcotic use for patients with chronic pain. Spinal stenosis is common in the older population, and more drug trials are needed for this condition.