Articles: low-back-pain.
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J Manipulative Physiol Ther · Jan 2002
Randomized Controlled Trial Clinical TrialThe reliability of multitest regimens with sacroiliac pain provocation tests.
Studies concerning the reliability of individual sacroiliac tests have inconsistent results. It has been suggested that the use of a test regimen is a more reliable form of diagnosis than individually performed tests. ⋯ A multitest regimen of 5 sacroiliac joint pain provocation tests is a reliable method to evaluate sacroiliac joint dysfunction, although further study is needed to assess the validity of this test method.
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The early studies on IDET are very promising. IDET offers patients with chronic discogenic low back pain an option other than chronic pain [figure: see text] management or spinal fusion. Studies currently under way will help answer questions relative to mechanism of action, placebo effect, and biomechanical changes after treatment. ⋯ This may be especially true for the young patient with preserved disc height, and patients with inoperable multilevel disease. The technology was designed to be used for a specific diagnostic subset of disc disorders by specialists skilled in performing intradiscal techniques who possess the ability to accurately diagnose and effectively manage patients with complex spinal disorders. Abuse of this ground-breaking technology can be avoided if patient selection criteria are carefully observed and only skilled, technically proficient physicians perform the procedure.
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Stud Health Technol Inform · Jan 2002
The significance of correlation of radiographic variables and MOS short-form health survey for clinical decision in symptomatic low back pain patients.
To assess any correlation between SF-36 scores and several lateral roentgenographic variables of the lumbar spine, both in low back pain patients and asymptomatic volunteers. The clinical relevance of the method proposed in this study to make a surgical strategy on the basis of distinct lateral roentgenographic parameters and conversely was assessed by independent radiologists and physicians. ⋯ SF-36 scores were correlated with distinct lateral roentgenographic variables of the lowermost lumbar spine (L4-S1) in low back patients, and of the whole lumbar spine in asymptomatic individuals. Clinical decision should not be taken on the basis of radiological evidence of pathology because clinical decision seems to be more accurate when is taken on the basis of combined SF-36 and roentgenographic data. However, clinical examination is mandatory to SF-36 questionnaire and radiographic analysis.
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To precisely evaluate low back pain, identification of the detailed innervation of the lumbar spine is necessary. On twenty-five sides of adult cadavers we investigated various patterns of rami communicantes (RC) and their relationship to the psoas major muscle (PM). In ten sides, we focused our dissection on the minute nerve supply of the anterior (ALL) and posterior longitudinal ligaments (PLL), vertebral bodies and the intervertebral discs (IVD). ⋯ Within the vertebral canal, the posterior aspect of IVD and PLL received the sinu-vertebral nerves originating from DTR. These findings suggest the coexistence of two different types of innervation: one originating directly from the spinal nerve segmentally, and one reaching vertebral structures via the sympathetic nerves non-segmentally. Therefore, sympathetic nerves are likely involved in the proprioception of the spinal column.
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To review the disposition and outcome of patients with back pain seen in a neurology clinic, and determine the value of the neurologist's input. ⋯ Of patients with back pain and related symptoms seen in a neurology clinic, about two thirds have non-neurologic conditions. These patients are usually treated symptomatically with medications, rest, and physical therapy, all of which could be managed by primary care physicians. In the neurologic group, the vast majority is treated in the same way as the non-neurologic group. When more specific measures are needed, such as surgery or pain management procedures (e.g., epidural blocks), then the patients could be evaluated directly by the proper specialist (pain management or spine surgery) rather than the neurologist. The neurologist's input does not significantly affect the diagnosis or the management, so that the neurologist appears to have no useful role in the management of such patients.