The spine journal : official journal of the North American Spine Society
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The relationship between the Tampa Scale of Kinesiophobia and low back pain rehabilitation outcomes.
The Tampa Scale for Kinesiophobia (TSK) is commonly used in clinical practice to quantify levels of pain-related fear of activity or re-injury in patients presenting with back pain. Patients with high levels of kinesiophobia are often considered at greater risk of developing long-term activity limitation and chronicity. There is, however, little evidence to support this assumption. ⋯ The TSK provides no benefit as a screening tool to predict pain, functional and work outcomes following rehabilitation. Measured changes in TSK scores following rehabilitation do not correlate strongly with similar, concordant changes in pain scores, functional levels, or return-to-work outcomes.
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There is little information regarding the surgical outcomes with regard to the timing of surgery in children under age 10 years for congenital scoliosis with a long-term follow-up. ⋯ In congenital scoliosis patients, posterior hemivertebra resection after pedicle screw fixation before the age of 6 years had significantly better deformity correction and did not cause a negative effect on the growth of vertebral body or spinal canal compared with the group treated after 6 years of age. Therefore, early surgical correction of a congenital hemivertebra in children under 6 years of age, before structural changes occur, effectively achieves a more satisfactory correction without causing iatrogenic spinal stenosis or neurologic complications compared with children older than 6 years but under 10 years of age.
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Facet joint orientation and tropism influence the biomechanics of the corresponding segment. Therefore, the sagittal orientation or tropism of the facet joint adjacent to the fusion segment seems a potential risk factor for adjacent segment degeneration. However, there have been no biomechanical studies regarding this issue. ⋯ Facet joint orientation and tropism at the adjacent segment influences the overstress of the adjacent segment, especially under the clinical circumstance of increased anterior shear force.
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Lumbar degenerative spondylolisthesis (DS) is a common, acquired condition leading to disabling back and/or leg pain. Although surgery is common used to treat patients with severe symptoms, there are no universally accepted treatment guidelines. Wide variation in vertebral translation, disc collapse, sagittal alignment, and vertebral mobility suggests this is a heterogeneous disease. A classification scheme would be useful to differentiate homogenous subgroups that may benefit from different treatment strategies. ⋯ A new radiographic and clinical classification scheme for lumbar DS with high inter- and intraobserver reliabilites is proposed. Use of this classification scheme should facilitate communication to enhance the quality of outcomes research on DS.
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Observational Study
Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement.
A subgroup of patients with acute to subacute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCIs) of the trunk. It is hypothesized that these patients have proprioceptive, postural, and movement control impairments of the trunk associated with LBP. Although trunk control impairments have been identified in patients with chronic LBP, they have not been investigated in this subgroup or closer to symptom onset. ⋯ Patients with clinical identification of trunk MCIs demonstrated decreased trunk motor control, suggesting that impairments in proprioception, motor output, or central processing occur early in the back pain episode. This information may help to guide interventions to address these specific limitations, improving delivery of care.