The spine journal : official journal of the North American Spine Society
-
Comparative Study
An economic model of one-level lumbar arthroplasty versus fusion.
Degenerative disc disease (DDD) is a cause of low back pain commonly requiring surgical intervention. The option of lumbar total disc replacement (TDR) represents an advance in the surgical treatment of DDD. However, new treatments, particularly those that include the use of new implants, may lead to increased costs to both hospitals and payers. Therefore, it is both necessary and appropriate to examine the potential costs associated with a new procedure such as total disc replacement compared with traditional treatments for a specific pathology. ⋯ The model shows that the overall economic effect of one-level TDR procedures on hospitals and payers is likely to be less than or at worse equivalent to one-level lumbar fusion procedures.
-
Diastematomyelia is a split-cord malformation often accompanied by other cord or column anomalies. ⋯ Initial presentation of diastematomyelia is rarely seen in adults; accompanying pathology includes scoliosis, tethered cord, and intradural tumors. Effective treatment involves identification of the primary pathology.
-
Changes in the lumbar foramen following anterior interbody fusion with tapered or cylindrical cages.
Anterior lumbar interbody fusion (ALIF) using both cylindrical and tapered threaded interbody cages has been shown to restore disc height, reduce segmental motion, and relieve low back pain. The effectiveness of these stand-alone cage designs in restoration and maintenance of intervertebral foraminal dimensions has received little attention. ⋯ Results from this bovine model biomechanical study indicate that stand-alone anterior interbody fusion cages with either tapered or cylindrical design are effective in restoring neuroforaminal height and stabilize the spine to withstand foraminal deformation during daily loading. The degree of stabilization was influenced substantially by the loading direction, to a lesser degree by the cage type, and was strongly dependent on the segment mobility. Although bovine lumbar spine is widely accepted for comparative studies, direct clinical interpretation should be made with caution owing to the anatomical differences from human.
-
In the assessment and treatment of chronic low back pain (CLBP) patients, the biopsychosocial model is used worldwide. Psychological distress has been reported to have a strong relationship with disability as measured with several instruments. The relationship between psychosocial distress measured with the Symptom Checklist-90-Revised (SCL-90-R) and self-reported disability measured with the Roland Morris Disability Questionnaire (RMDQ) has not been investigated. ⋯ The relationship between psychosocial distress measured with the SCL-90-R and self-reported disability measured with the RMDQ in CLBP patients is weak.
-
Past studies have shown that proportion of lumbar fusion surgery to all forms of lumbar surgery is variable among geographic regions. At present, no studies have investigated whether fusion outcome is associated with geographic region. ⋯ The findings suggest that surgical fusion outcome is associated with regional variations. It is likely that patient selection and physician preferences are associated with these findings. Similar to variations in proportion of lumbar fusion surgery among geographic regions, outcomes for surgical fusions also vary across regions.