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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Providing information to patients regarding appropriate management of LBP is a crucial component of primary care and treatment of low back pain (LBP). Limited knowledge is available, however, about the information delivered by physicians to patients with low back pain. Hence, this study aimed at evaluating (1) the self-reported practices of French physicians concerning information about patients with acute LBP (2) the consistency of these practices with the COST B13 guidelines, and (3) the effects of the delivery of a leaflet summarizing the COST B13 recommendations on the management of patient information, using the following study design: 528 French physicians [319 general practitioners (GP) and 209 rheumatologists (RH)] were asked to provide demographic information, responses to a Fear Avoidance Beliefs questionnaire adapted for physicians and responses to a questionnaire investigating the consistency of their practice with the COST B13 guidelines. ⋯ The results indicated that GP were less consistent with the European COST B13 guidelines on the information of patients with acute LBP than RH. Interestingly, delivery of a summary of these guidelines to GP improved their consistency score, but not that of the RH. This suggests that GP information campaign can modify the message that they deliver to LBP, and subsequently could change patient's beliefs on LBP.
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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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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.
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Comparative Study
The growth of different body length dimensions is not predictive for the peak growth velocity of sitting height in the individual child.
The aim of this study was to determine whether the differences in timing of the peak growth velocity (PGV) between sitting height, total body height, subischial leg length, and foot length can be used to predict whether the individual patient with adolescent idiopathic scoliosis is before or past his or her PGV of sitting height. Furthermore, ratios of growth of different body parts were considered in order to determine their value in prediction of the PGV of sitting height in the individual patient. Ages of the PGV were determined for sitting height (n=360), total body height (n=432), subischial leg length (n=357), and foot length (n=263), and compared for the whole group and for the individual child in particular. ⋯ The variation over children was large and the ratios were too small, leading to a too large influence of measurement errors. The mean ages of the PGV all differed significantly from the mean age of the PGV of sitting height. However, the variation over individual children of the age differences in PGV between body dimensions was large, and the differences in timing of the PGV were not useful to predict whether the individual child is before or past his or her PGV of sitting height.