Articles: low-back-pain.
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Many people with recurrent low back pain (LBP) have deficits in postural control of the trunk muscles and this may contribute to the recurrence of pain episodes. However, the neural changes that underlie these motor deficits remain unclear. As the motor cortex contributes to control of postural adjustments, the current study investigated the excitability and organization of the motor cortical inputs to the trunk muscles in 11 individuals with and without recurrent LBP. ⋯ The location of the CoG and the map volume were correlated with onset of TrA EMG during rapid arm movements. Furthermore, the MT needed to evoke ipsilateral responses was lower in the LBP group, but only on the less excitable hemisphere. These findings provide preliminary evidence of reorganization of trunk muscle representation at the motor cortex in individuals with recurrent LBP, and suggest this reorganization is associated with deficits in postural control.
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Epiduroscopy is a relatively new diagnostic and therapeutic technique used in patients with chronic low back pain with or without radiculopathy. We present our experience with a new interlaminar approach in patients with failed back surgery syndrome (FBSS). ⋯ We have described a new procedure for epiduroscopy with approximately 50% reduced outer diameter of the catheter, which allows interlaminar approach. Its diagnostic efficacy is clear and there were a significant number of patients who had improved outcome.
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Minim Invas Neurosur · Aug 2008
Multicenter StudyPercutaneous axial lumbar interbody fusion (AxiaLIF) of the L5-S1 segment: initial clinical and radiographic experience.
Anterior access to the L5-S1 disc space for interbody fusion can be technically challenging, frequently requiring the use of an approach surgeon for adequate exposure. We reviewed our experience with a novel minimally invasive technique for L5-S1 interbody fusion that exploits the presacral space and its relative dearth of critical structures. ⋯ The percutaneous paracoccygeal approach to the L5-S1 interspace provides a minimally invasive corridor through which discectomy and interbody fusion can safely be performed. It can be used alone or in combination with minimally invasive or traditional open fusion procedures. It may provide an alternative route of access to the L5-S1 interspace in those patients who may have unfavorable anatomy for or contraindications to the traditional open anterior approach to this level.
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Randomized Controlled Trial Multicenter Study
Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain.
Sacroiliac joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for sacroiliac joint pain. ⋯ These results provide preliminary evidence that L4 and L5 primary dorsal rami and S1-S3 lateral branch radiofrequency denervation may provide intermediate-term pain relief and functional benefit in selected patients with suspected sacroiliac joint pain. Larger studies are needed to confirm these results and to determine the optimal candidates and treatment parameters for this poorly understood disorder.
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Curr Opin Anaesthesiol · Aug 2008
ReviewRecent advancements in the treatment of lumbar radicular pain.
Lumbar radicular pain is a common and often difficult condition to treat. Current literature supports the theory that radicular pain is at least in part due to an inflammatory process involving cytokines, including tumor necrosis factor alpha and interleukins. This review summarizes some of the most recent research concerning the use of tumor necrosis factor alpha antagonists and interleukin receptor antagonists in the treatment of lumbar radicular pain. ⋯ Treatment for lumbar radicular pain has long included epidural steroids to inhibit the inflammatory component of radicular pain. Recent studies have more precisely identified the cytokines responsible for this inflammatory process and indicate that inhibition of these cytokines may offer more specific and effective treatment for lumbar radicular pain.