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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Superiority of pedicle screws over hybrid/hook instrumentation or vice versa in the treatment of Lenke Type 1 and 2 adolescent idiopathic scoliosis (AIS) remains unresolved for moderate curves. Our objective was therefore to compare the assessment of pedicle screw and hybrid/hooks instrumentation with special attention to cosmesis and uninstrumented spine using novel assessment methods. We carried out a retrospective study of radiographs and clinical photos of 40 cases of thoracic AIS between 40 degrees and 70 degrees of Cobb angle Lenke Type 1 and 2, treated with either pedicle screws or hybrid/hooks. ⋯ Out of the 160 guesses by surgeons of the cases with instrumentation blocked in the radiographs, they were unable to guess the instrumentation in 92% of the cases. Objective assessment of all variables and SRS-24 scores of all five domains showed no significant difference by instrumentation (P > or = 0.05). In this first-ever conducted study in a blinded-fashion, we conclude that there is no significant difference between the pedicle screw and hybrid/hooks instrumentations used to treat AIS for Lenke Type 1 and 2 curves for moderate curves between 40 degrees and 70 degrees .
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Percutaneous vertebroplasty, comprising of the injection of polymethylmethacrylate (PMMA) into vertebral bodies, is an efficient procedure to stabilize osteoporotic compression fractures as well as other weakening lesions. Besides fat embolism, cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the PMMA during injection plays a key role in this context. ⋯ Normalized injection forces (by viscosity and injection speed) showed a trend to be lower for the lavage group in comparison to the control group (P = 0.073). In conclusion, the clinical relevance on the investigated lavage technique concerning lowering injection forces was only shown by trend in the performed animal study. However, it might well be that the effect is more pronounced for osteoporotic vertebral bodies.
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Randomized Controlled Trial Multicenter Study Comparative Study
Aceclofenac-tizanidine in the treatment of acute low back pain: a double-blind, double-dummy, randomized, multicentric, comparative study against aceclofenac alone.
Tizanidine and aceclofenac individually have shown efficacy in the treatment of low back pain. The efficacy and tolerability of the combination have not yet been established. The objective of the study was to evaluate the efficacy and safety of aceclofenac-tizanidine fixed dose combination against aceclofenac alone in patients with acute low back pain. ⋯ There were significantly more number of patients with excellent to good response for the aceclofenac-tizanidine treatment as compared to aceclofenac alone (P = 0.00). Both the treatments were well tolerated. In this study, aceclofenac-tizanidine combination was more effective than aceclofenac alone and had a favourable safety profile in the treatment of acute low back pain.
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Randomized Controlled Trial
No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy.
Low back pain (LBP) poses a significant problem to society. Although initial conservative therapy may be beneficial, persisting chronic LBP still frequently leads to expensive invasive intervention. A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy (IDD Therapy, North American Medical Corp. ⋯ None of the parameters showed a difference between both protocols. Both treatment regimes had a significant beneficial effect on LBP, leg pain, functional status and quality of life after 14 weeks. The added axial, intermittent, mechanical traction of IDD Therapy to a standard graded activity program has been shown not to be effective.
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Psychological factors have been found to be of major importance for the transition from acute to chronic low back pain (CLBP). Although some evidence has been provided that depressive symptoms occur secondarily to CLBP, psychological treatment modules that specifically address depressive symptoms are not yet included in German inpatient rehabilitation programs. In this study, a standard rehabilitation program for patients with CLBP and depressive symptoms was compared to a standard rehabilitation, into which a cognitive-behavioral management training of depressive symptoms was integrated. ⋯ Females benefited more in mental health than males. However, due to regression effects at the 12-month follow-up assessment, booster sessions are highly recommended. The results presented here support the notion that a more adequately tailored rehabilitation program seems to improve rehabilitation success and prevent further development of CLBP among this high-risk subpopulation.