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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Epidural steroid injections are an important therapeutic modality employed by spinal surgeons in the treatment of patients with chronic low back pain with or without lumbar radiculopathy. The caudal epidural is a commonly used and well-established technique; however, little is known about the segmental level of pathology that may be addressed by this intervention. This prospective study of over 50 patients aimed to examine the spreading pattern of this technique using epidurography. ⋯ Although in selected cases thoracic and high lumbar levels can be reached, this is variable. If pathology at levels above L3 needs to be addressed, we propose a 30° head tilt may improve cephalic drug delivery. The caudal route is best reserved for pathology below L3.
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The analysis of the sagittal balance is important for the understanding of the lumbopelvic biomechanics. Results from previous studies documented the correlation between sacro-pelvic orientation and lumbar lordosis and a uniqueness of spino-pelvic alignment in an individual person. This study was subjected to determine the lumbopelvic orientation using pelvic radius measurement technique. ⋯ T12-S1 was significantly increased when PR-S1 was lesser than average (35°-45°) and was significantly decreased when PR-S1 was above the average. PR-L4 and PR-L5 were significantly reduced when PR-S1 was smaller than average and only PR-L5 was significantly increased when PR-S1 was above the average. In conclusion, this present study supports that lumbar spine and pelvis work together in order to maintain lumbopelvic balance.
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Comparative Study
Role of rod diameter in comparison between only screws versus hooks and screws in posterior instrumentation of thoracic curve in idiopathic scoliosis.
Since the introduction of Cotrel-Dubousset instrumentation in 1984, the correction techniques in scoliosis surgery have changed from Harrington principles of concave distraction to segmental realignment to a variety of possibilities including the rod rotation manoeuvres, and to segmental approximation via cantilever methods. Additionally, pedicle screw utilization in lumbar curves enhanced correction and stabilization of various deformities, and various studies have strongly supported the clinical advantages of lumbar pedicle screws versus conventional hook instrumentation. Pedicle screw constructs have become increasingly popular in the treatment of patients with spinal deformity. ⋯ Our results show that the percentage of correction of idiopathic thoracic scoliosis is similar when treating the scoliosis with rods and screws alone or with rods, screws and hooks; therefore, we and the majority of authors in the literature do not consider the rod section. This can be an important parameter in the evaluation of the superiority of treatment with screws only or screws and hooks. In our study, even if not of statistical significance, the better thoracic curve correction obtained with the hybrid group should be ascribed to the fact that in this group mostly 6 mm rods were used.
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This paper quantifies the relationship between early retirement due to back problems and wealth, and contributes to a more complete picture of the full costs associated with back problems. The output data set of the microsimulation model Health&WealthMOD was analysed. Health&WealthMOD was specifically designed to measure the economic impacts of ill health on Australian workers aged 45-64 years. ⋯ Of those who have retired early due to back problems who do have some wealth, on average the total value of this wealth is 87% less (95% CI: -90 to -84%) than the total value of wealth accumulated by those who have remained in full-time employment with no health condition controlling for age, sex and education. The financial burden placed on those retiring early due to back problems is likely to cause financial stress in the future, as not only have retired individuals lost an income stream from paid employment, but they also have little or no wealth to draw upon. Preventing early retirement due to back problems will increase the time individuals will have to amass savings to finance their retirement and to protect against financial shocks.
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Comparative Study
Operative treatment of isthmic spondylolisthesis in children: a long-term, retrospective comparative study with matched cohorts.
The purpose of the present study was to compare the long-term clinical, functional and radiographic outcomes of young patients operated on before or at the onset of puberty (Children) and those operated on after that (Adolescents). The study group consisted of 298 patients operated on under the age of 20 years; 55 of them were operated on before or at the onset of growth spurt (29 females<12.5 years, 26 males<14.5 years). Preoperative data were retrieved from patients' records. ⋯ In the children with high-grade slips, there was a mean slip improvement of 14 percentage points due to remodelling. The overall complication rate in the whole population was 7.7%. In conclusion, spinal fusion can be carried out at an early age for low- and high-grade spondylolisthesis with good long-term clinical, functional, radiographic and health-related quality-of-life outcomes when the indications are met.