European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Comparative Study
Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion.
Posterior lumbar interbody fusion (PLIF) restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance. It immobilizes the painful degenerate spinal segment and decompresses the nerve roots. Anterior lumbar interbody fusion (ALIF) does the same, but could have complications of graft extrusion, compression and instability contributing to pseudarthrosis in the absence of instrumentation. ⋯ There was no significant difference between the compensation rate and disability benefit rate between the two groups. There were three complications in ALIF group and four in the PLIF (circumferential) group. On the basis of these results, we conclude that it is possible to treat discogenic back pain by anterior interbody fusion with Hartshill horseshoe cage or with circumferential fusion using instrumented PLIF.
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Comparative Study
Comparative study of laparoscopic L5-S1 fusion versus open mini-ALIF, with a minimum 2-year follow-up.
Anterior lumbar interbody fusion (ALIF) is a widely accepted tool for management of painful degenerative disc disease. Recently, the modern laparoscopic surgical technique has been combined with ALIF procedure, with good early postoperative results being reported. However, the benefit of laparoscopic fusion is poorly defined compared with its open counterpart. ⋯ After a follow-up period of at least 2 years, the two groups showed no statistical difference in pain, measured by visual analog scale, in the Oswestry Disability Index or in the Patient Satisfaction Index. The fusion rate was 91% in both groups. The laparoscopic ALIF for L5-S1 showed similar clinical and radiological outcome when compared with open mini-ALIF, but significant advantages were not identified, despite its technical difficulty.
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The objective of this cross-sectional study was to study associations between low back pain (LBP) and modes of transport to school and leisure activities among adolescents. The study population included all adolescents in eighth and ninth grade in two geographic areas in eastern Norway. Eighty-eight adolescents participated (mean age 14.7 years), making the response rate 84%. ⋯ Walking/bicycling more than 8 km weekly to regular activities was inversely associated with LBP in multivariate analysis (OR 0.3; 95% confidence interval 0.1-1.0). No associations were found between passive journeys and LBP. The results raise the question for future research of whether lack of active transport may be one cause behind the increase in juvenile LBP.
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Intervertebral cages in the lumbar spine represent an advancement in spinal fusion to relieve low back pain. Different implant designs require different endplate preparations, but the question of to what extent preservation of the bony endplate might be necessary remains unanswered. In this study the effects of endplate properties and their distribution on stresses in a lumbar functional spinal unit were investigated using finite-element analyses. ⋯ Stress distributions were similar for the two endplate preparation techniques of complete endplate preservation and partial endplate removal from the centre. It can be concluded that cages should be designed such that they rely on the strong peripheral part of the endplate for support and offer a large volume for the graft. Furthermore, the adjacent vertebrae should be assessed to ensure that they show sufficient density in the peripheral regions to tolerate the altered load transfer following cage insertion until an adequate adaptation to the new loading situation is produced by the remodelling process.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of behavioral graded activity after first-time lumbar disc surgery: short term results of a randomized controlled trial.
Behavioral approaches to treating patients following lumbar disc surgery are becoming increasingly popular. The treatment method is based on the assumption that pain and pain disability are not only influenced by somatic pathology, if found, but also by psychological and social factors. A recent study highlighted the effectiveness of cognitive-behavioral interventions, as compared to no treatment, for chronic low back patients. ⋯ For Global Perceived Effect there was a borderline statistically significant difference to the advantage of the UC group. On functional status and all other outcome measures there were no relevant differences between interventions. The number of re-operations was negligible, indicating that it is safe to exercise after first-time disc surgery.