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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We have previously shown that the lumbar spine has an intrinsic shape specific to the individual and characteristic of sitting, standing and supine postures. The purpose of this study was to test the hypothesis that this intrinsic shape is detectable throughout a range of postures from extension to full flexion in healthy adults. ⋯ This study shows that an individual's intrinsic lumbar spine shape is quantifiable and detectable throughout lumbar flexion and extension. These findings will enable the role of lumbar curvature in injury and low back pain to be assessed in the clinic and in the working and recreational environments.
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The anterior approach is widely used for access to the lumbar spine in the setting of adult deformity either as a stand-alone procedure or in combined anterior-posterior procedures. Access-related complication rates have so far not been reported in an elderly patient population, in which it has been suggested that anterior lumbar surgery is indicated with caution. Here, the complication rates in patients over 60 years of age are reported. ⋯ Anterior lumbar surgery in an elderly population does not necessarily have higher overall complication rates than in a younger population. The risk of vascular injury requiring repair was higher, but has not resulted in major blood loss and the procedure therefore can be carried out safely. The overall complication rate and blood loss compare favourably to complication rates in posterior adult deformity procedures.
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Healthy subjects performed lumbar flexion and were assessed by video fluoroscopy to measure the in vivo kinematics of the lower lumbar motion segments. ⋯ L4-L5 exhibited the largest anterior and posterior margin strains (29 and 65%, respectively). Strains in the disc during in vivo lumbar flexion are due to both angular rotation and linear translation.
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Rett syndrome is a progressive neurodevelopmental disorder that predominantly affects females and is associated with a high incidence of scoliosis and epilepsy. There is scant published work about intraoperative spinal cord monitoring in these patients and little more regarding the rate of perioperative complications. We investigated our institutions' experience with both. ⋯ Scoliosis surgery in patients with Rett syndrome carries a very high rate of complications and an average hospital stay approaching 3 weeks. Both caregivers and surgeons should be aware of this when planning any intervention. These patients frequently have useful lower limb function and spinal cord monitoring is a valid tool to aid in its preservation. We would suggest aggressive optimisation of these patients prior to surgery, with an emphasis on nutrition.
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Observational Study
Shared decision-making in back pain consultations: an illusion or reality?
Amid a political agenda for patient-centred healthcare, shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that shared decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of shared decision-making in clinical encounters involving physiotherapists and patients with back pain. ⋯ Shared decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to shared decision-making and further work should focus on when and how it can be implemented.