The spine journal : official journal of the North American Spine Society
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Vertebroplasty (VP) and kyphoplasty (KP) are routinely used to treat vertebral body compression fractures (VCFs) resulting from osteoporosis or vertebral body tumors in order to provide rapid pain relief. However, it remains debated whether VP or KP results in superior outcomes versus medical management alone in patients experiencing VCFs. ⋯ Although evidence suggests that physical disability, general health, and pain relief are better with VP and KP than those with medical management within the first 3 months after intervention, high-quality randomized trials with 2-year follow-up are needed to confirm this. Furthermore, the reported incidence of symptomatic procedure-related morbidity for both VP and KP is very low.
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Case Reports
An unusual cause of sciatic pain as a result of the dynamic motion of the obturator internus muscle.
It has been reported that compression of the sciatic nerve because of any cause, including endometriosis, piriformis syndrome, abscess, tumor, adjoining uterus provoke sciatic pain. Some of these pathophysiologies have been diagnosed clinically and sometimes by exclusion. ⋯ Although it may not be common, compression of the sacral plexus caused by dynamic motion of the obturator internus muscle should be included as a possible diagnosis for sciatic pain.
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Studies have suggested that the use of bone marrow aspirate (BMA) with HEALOS (DePuy Spine, Raynham, MA), a collagen-hydroxyapatite sponge (CHS), is an effective substitute for autologous iliac crest bone graft when used in fusion procedures of the lumbar spine. ⋯ At the 2-year follow-up, BMA/CHS showed acceptable fusion rates in patients undergoing TLIF/PLF, and can be considered as an alternative source of graft material.
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Epidural injections are commonly used to treat low back disorders. It has been proposed that in addition to the anti-inflammatory effects, injected material displaces the dura forward and inward, producing a stretch of the nerve roots that leads to lysis of neural adhesions. Despite this, there are no controlled trials investigating the effect of volume injected with pain as an independent outcome. ⋯ These preliminary results suggest a positive correlation between larger volumes of fluid injected in the epidural space and greater relief of radicular leg pain and/or low back pain. Clinicians should not change their practice, until further high-quality clinical studies confirm these findings.
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Questionnaires for measuring the functional status of patients with low back pain (LBP) focus on disability and present responses for each question in a predetermined, fixed relationship between "can do/difficulties and pain." Their design does not permit a separation of the two. ⋯ The construction of the POP allows the patient to count, and the occupational therapist to investigate, from full level of activity to avoidance and from no pain to worst imaginable pain for each physically loaded task in personal activities of daily living (ADL), transfer/transport, instrumental ADL, and social activities. The POP can differentiate between groups concerning level of activity and pain, and appears to be a valid and reliable instrument for evaluating LBP. The POP should be considered for use in both clinical and research applications.