Articles: back-pain.
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Wei et al. evaluated the global research in spine using scientometric methods based on a sample of 13,115 papers published in 5 spine journals from 2004 to 2013. This study builds on this pioneering study and provides up-to-date and thorough information on spine based on a sample of 166,962 papers for the stakeholders. ⋯ The optimal design of research sample made it possible to obtain nearly 13 times the size of the sample in Wei et al. as a true representation of the research in spine through the use of an optimal keyword set for the titles of both papers and 10 spine journals. However, despite the inefficient design of the incentive structures for the relevant stakeholders, the research in spine had expanded 6.8 times since 1980.
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Observational Study
Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients.
To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery. ⋯ Mild-moderate respiratory depression is observed following a one-time dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.
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The intervertebral disc has been implicated as a major cause of chronic spinal pain based on clinical, basic science, and epidemiological research. There is, however, a lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26% to 39% of patients, and in 16% to 53% of patients with pain in the cervical spine. Lumbar, cervical, and thoracic provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature on point, intense debate continues about lumbar discography as a diagnostic tool. ⋯ Lumbar intervertebral disc, cervical intervertebral disc, thoracic intervertebral disc, discography, provocation discography, analgesic discography, diagnostic accuracy, prevalence.
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Case Reports
Back pain in the emergency department: Pathological fracture following spinal manipulation.
Back pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. ⋯ Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma. We have explored current literature examining the prevalence of lower back pain, as well as the incidence of spinal fracture following chiropractic manipulation, and have highlighted a potential complication from chiropractic manipulation in a patient with an undiagnosed underlying neoplastic disorder.
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To evaluate the effect of pulsed radiofrequency (PRF) stimulation of the thoracic medial branch of the dorsal ramus in patients with chronic thoracic facet joint (TFJ) pain who were refractory to medial branch block (MBB). ⋯ The author suggests that PRF on the thoracic medial branch is an effective and safe interventional technique for the control of chronic TFJ pain.