The spine journal : official journal of the North American Spine Society
-
Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP). ⋯ Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.
-
Surgical indications and procedures for spinal Langerhans cell histiocytosis (LCH) in children are still controversial. Reports containing large samples of surgically treated patients are few in the currently available literature, and the reported operative procedures were also somewhat obsolete. So, further investigation based on large-sample cases and using improved surgical techniques is beneficial and helpful to refine the treatment strategy. ⋯ For spinal LCH patients, neurologic deficit is a main indication for operative treatment to prevent permanent and serious consequences. Surgery provides an opportunity for rapid recovery of neurologic function. Both combined and single-stage posterior approaches based on pedicle screw instrumentation techniques are similarly effective in relieving neurologic compression. However, single-stage posterior approach is more favorable with less complications, and preserving involved vertebral body is not a latent hazard of recurrence.
-
The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. ⋯ Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.
-
The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery. ⋯ Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
-
Lateral lumbar interbody fusion (LLIF) has become an increasingly common minimally invasive procedure for selective degenerative deformity correction, reduction of low-grade spondylolisthesis, and indirect foraminal decompression. Concerns remain about the safety of the transpsoas approach to the spine due to proximity of the lumbosacral plexus. ⋯ Although LLIF is associated with an increased prevalence of anterior thigh/groin pain as well as motor and sensory deficits immediately after surgery, our results support that pain and neurologic deficits decrease over time. The level treated appears to be a risk factor for lumbosacral plexus injury.