The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
Disc height and motion patterns in the lumbar spine in patients operated with total disc replacement or fusion for discogenic back pain. Results from a randomized controlled trial.
Fusion is considered the "gold standard" in surgical treatment of degenerated disc disease; the intended postoperative goal is absence of mobility, but treatment may induce degeneration in adjacent segments. Total disc replacement (TDR) aims to restore and maintain mobility by replacing a painful disc. Little is known about the degree and quality of mobility in artificial discs in vivo and whether maintained mobility reduces the stress on adjacent segments that is believed to occur after fusion. ⋯ This very accurate X-ray method (DCRA) indicates that surgical goals were reached in most patients. This, however, was not correlated to clinical outcome. Differences between the groups in postoperative disc height at treated segments, respective ROM, and translation at adjacent segments did not affect the clinical outcome after 2 years.
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Randomized Controlled Trial
No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises.
Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. ⋯ Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up.
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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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Randomized Controlled Trial Comparative Study
Comparison of clinical effectiveness of cervical transforaminal steroid injection according to different radiological guidances (C-arm fluoroscopy vs. computed tomography fluoroscopy).
Transforaminal steroid injection using C-arm fluoroscopy has been regarded as a useful method of treatment for cervical herniated disc. But C-arm fluoroscopy cannot identify soft tissue; so there is controversy about its safety and efficacy. Computed tomography (CT) fluoroscopy permits precise anatomical resolution and has the potential to offer a safer technique compared with C-arm fluoroscopy. ⋯ The CT group, without any side effects, showed the better effectiveness than the C-arm group in the improvement of radiating pain and functional status in patients with cervical disc herniation. Therefore, CT fluoroscopy can be a substitute for C-arm fluoroscopy in transforaminal steroid injection when treating patients with cervical disc herniation.
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Randomized Controlled Trial
Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes.
The effect of intradiscal steroid therapy for patients with degenerative chronic discogenic low back pain remains an issue of debate. ⋯ Intradiscal injection of corticosteroids could be a short-term efficient alternative for discogenic low back pain patients with end plate Modic changes on MRI who were still unwilling to accept surgical operation when conservative treatment failed.