The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial.
Several conservative therapies have been shown to be beneficial in the treatment of chronic low back pain (CLBP), including different forms of exercise and spinal manipulative therapy (SMT). The efficacy of less time-consuming and less costly self-care interventions, for example, home exercise, remains inconclusive in CLBP populations. ⋯ For CLBP, supervised exercise was significantly better than chiropractic spinal manipulation and home exercise in terms of satisfaction with treatment and trunk muscle endurance and strength. Although the short- and long-term differences between groups in patient-rated pain, disability, improvement, general health status, and medication use consistently favored the supervised exercise group, the differences were relatively small and not statistically significant for these individual outcomes.
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Posterior lumbar interbody fusion (PLIF) using harvested local bone inserted into a polyetheretherketone (PEEK) cage is a commonly used procedure, but the accurate fusion rate of a cage, cage to bone contact area ratio, and the changes in fusion rate with time after surgery are unknown. ⋯ The fusion rate of the PEEK cage used in PLIF measured at 12 months was higher than that measured at 6 months. Therefore, an assessment on the complete fusion of local bone at 12 months after surgery is more accurate.
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Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis.
Lumbar spinal stenosis is now the most common and fastest growing reason for spinal surgery in adults older than 65 years. There are not yet clearly identified preoperative predictive factors for postoperative clinical outcome. We have previously reported on the clinical outcome of patients treated operatively and nonoperatively. ⋯ On average, patients who choose to have surgery will have improvement. However, not all patients having surgery will note improvement, and there are factors predictive for outcome.