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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Randomized Controlled Trial
Cost-effectiveness of a classification-based system for sub-acute and chronic low back pain.
Identifying relevant subgroups in patients with low back pain (LBP) is considered important to guide physical therapy practice and to improve outcomes. The aim of the present study was to assess the cost-effectiveness of a modified version of Delitto's classification-based treatment approach compared with usual physical therapy care in patients with sub-acute and chronic LBP with 1 year follow-up. ⋯ The classification-based treatment approach as used in this study was not cost-effective in comparison with usual physical therapy care in a population of patients with sub-acute and chronic LBP.
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Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion. ⋯ The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.
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RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain.
Supra-physiological rhBMP loads during spinal fusion may trigger local inflammation and post-operative radiculitis. MRI is an effective tool to detect nerve root compression in severe post-operative leg pain. The aim of this study was to determine if recombinant bone morphogenic protein 2 (rhBMP-2) is associated with immediate post-operative leg pain without evidence of root compression using MRI. ⋯ III.
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Shoulder-pelvic integration could play a central role in the control of dynamic posture and movement. However, kinematic coordination during axial trunk rotation has not been carefully investigated in subjects with recurrent low back pain (LBP). The purpose of this study was to compare the maximum rotational angles of the shoulders and pelvis in the transverse plane between subjects with and without recurrent LBP. ⋯ These results indicated a different pattern of trunk rotation movement with the age and BMI serving as important factors to consider for recurrent LBP. The results of our study also indicated a different pattern of shoulder and pelvic coordination with age and gender. Clinicians need to consider the consequences of limited shoulder-pelvic rotational angles, especially limited rotational angle on the pelvis during trunk axial rotation. Further studies are required to determine the causes of the underlying problems for clinical decision-making and altered shoulder-pelvic rotation in subjects with recurrent LBP.
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Comparative Study
Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian-Portuguese language.
The use of patient-orientated questionnaires is of utmost importance in assessing the outcome of spine surgery. Standardisation, using a common set of outcome measures, is essential to aid comparisons across studies/in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders. This study aimed to produce a Brazilian-Portuguese version of the COMI. ⋯ The reproducibility of the Brazilian-Portuguese version of the COMI was comparable to that of other language versions. The COMI scores correlated in the expected manner with existing but longer symptom-specific questionnaires suggesting good convergent validity for the COMI. The Brazilian-Portuguese COMI represents a valuable tool for Brazilian study-centres in future multicentre clinical studies and surgical registries.