Articles: back-pain.
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Review Meta Analysis
Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.
Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. ⋯ When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.
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To examine whether there are differences between non-trauma-exposed, trauma-exposed without posttraumatic stress symptoms (PSS), and trauma-exposed with PSS chronic musculoskeletal pain patients in vulnerability, protective, and pain-adjustment variables; to test the interactive relationship between PSS and the vulnerability and protective psychological variables across pain adjustment in the group of trauma-exposed-patients. ⋯ The current study supports the models of posttraumatic stress and chronic pain, such as the mutual maintenance and the shared vulnerability theories, providing an initial comprehensive framework for understanding the comorbidity of both disorders.
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Review Case Reports
Necrotizing sarcoid granulomatosis with an uncommon manifestation: clinicopathological features and review of literature.
We report a rare case of an incidental diagnosis of necrotizing sarcoid granulomatosis (NSG) in a 60-y-old non-smoking male. The patient was admitted to the hospital for sudden back pain. Chest x-ray revealed areas of parenchymal consolidation and high-resolution computed tomography demonstrated a pulmonary nodular pattern with no lymph node enlargement. ⋯ The diagnosis of NSG was made by histopathological examination of a surgical lung biopsy and by excluding other causes of granulomatous disease. In paucisymptomatic/asymptomatic patients, as in our case, therapy is not necessary, with a good prognosis and complete recovery. NSG is a rare systemic disease similar to sarcoidosis and Wegener's granulomatosis with a benign clinical course and should always be considered for patients with nodular pulmonary lesions even with subclinical or uncommon features.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2014
Percutaneous endoscopic lumbar discectomy and annuloplasty for lumbar disc herniation at the low two contiguous levels: single-portal, double surgeries.
Technical case report. ⋯ Transforaminal PELDA to treat two levels of LDH through a single portal could be considered as one of the minimally invasive treatment modalities that avoids conventional open surgery.
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Observational Study
Real-life results of balloon kyphoplasty for vertebral compression fractures from the SWISSspine registry.
The Swiss Federal Office of Public Health mandated a nationwide health technology assessment-registry for balloon kyphoplasty (BKP) for decision making on reimbursement of these interventions. The early results of the registry led to a permanent coverage of BKP by basic health insurance. The documentation was continued for further evidence generation. ⋯ The results of the largest observational study for BKP so far are consistent with published randomized trials and systematic reviews. In this routine health care setting, BKP is safe and effective in reducing pain, improving QoL, and lowering pain_killer consumption and has an acceptable rate of cement extrusions. Postoperative outcome results show clear and significant clinical improvement at early follow-up that remain stable during the first postoperative year.