Background: The prevalence and incidence of low back pain in general society is high. Workers whose job involves walking long distances have even a higher tendency to suffer from low back pain.

Purpose: Our goal was to examine the effect of insoles on low back pain among workers whose job involves long-distance walking.

Methods: In this double blind prospective study we examined the effectiveness of insoles constructed in a computerized method to placebo insoles in 58 employees whose work entailed extensive walking and who suffered from low back pain. The evaluation was performed by the MILLION questionnaire.

Results: 81% of the employees preferred the real insoles in comparison to 19% of the users of the placebo insoles (p < 0.05). A substantial improvement in the LBP after the use of the true insoles was noted.. The average pain intensity before the use of the insoles was 5.46. However, after the use of the real insoles and the placebo insoles the average pain intensity decreased to 3.96 and 5.11 respectively. The difference of the average pain intensity at the start of the study and after the use of the real insoles was significant: −1.49 (p=0.0001), whereas this difference after the use of the placebo insoles was not significant: −0.31 (p=0.1189). A level 5 pain and above was reported by 77% of the subjects at the start of the study. After the use of the real insoles 37.9% of the subjects reported a similar degree of pain severity, and 50% of the subjects did so after the use of the placebo (p< 0.05).

Conclusions: LBP decreased significantly after the use of real insoles compared to placebo ones.

Objective: To determine the late (2–5 years) clinical results of surgery for herniated lumbar disc (HLD) as related to duration of preoperative symptoms and type of herniation.

Methods: The study was limited to 63 adult Moslem Arab residents of the hospital’s catchment area. All subjects had been scored for pre and postoperative leg pain and for related disability using a 0–11 visual analog scale and a functional grading system (Spangfort’s), respectively. Relationships between duration of preoperative symptoms and extent of disc herniation with the above scores were statistically analyzed.

Results: The mean overall score for leg pain decreased from 7.2 ± 2.0 (preoperatively) to 3.4 ± 2.4, a mean reduction (ΔVAS) of 3.1 ± 2.7, a 43.3% change (P< 0.001). Patients operated upon within 4 weeks after onset of symptoms attained the highest degree of leg pain relief (ΔVAS 4.3 ± 2.6), those operated within 4–12 weeks reported the least relief of leg pain (ΔVAS 1.7 ± 2.8). Paradoxically, patients who underwent surgery after 12 weeks received better results than the 4 – 12 week group (ΔVAS 3.0 ± 1.3). Patients with non-contained herniation reported a more intense preoperative leg pain than those defined as contained (VAS 8.3 vs. 6.5), were operated earlier (7.4 vs. 15.8 weeks), and their functional outcome was graded as better (Good/Fair in 96.4% vs. 74.3%).

Conclusions: Patients with incapacitating radicular pain, not responding to conservative treatments, are best operated upon within 6 weeks of onset. Surgery for non-contained herniation achieves a higher long-term success rate, probably since severe pain hastens surgical procedure, thereby preventing irreversible root damage.

Radiofrequency (RF) lesions have been used for over 25 years in the treatment of intractable pain of spinal origin. The conventional understanding of this technique is that the heat which is produced in the tissue surrounding the electrode tip causes destruction of nervous tissue, which in turn reduces the input of noxious nerve stimuli and alleviates pain. Neuropathic pain is usually a contra-indication to the use of RF nerve lesioning. For treatment of patients with severe radicular pain we use pulsed radiofrequency who has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of rise in temperature or subsequent nerve injury.

This study reports the effect of pulsed RF in 21 patients with severe radicular pain who had previously failed to respond to conventional therapy.

Patients and Methods: From December 2000 to August 2001, 18 patients underwent pulsed RF Rhizotomy of Dorsal Root Ganglion (DRG) of segmental N. Root of the painful dermatome. Out of them, 16 passed treatment in the lumbar area and 2 in the neck. The age of the patients ranged from 20 to 75 years (m=55.7 years). Male/female ratio was 1.4/1. 50% was previously operated (discectomy, laminectomy). No complications were seen either in the procedure or in the follow-up.

Results: Out of 21 patients, 3 (14.3%) did not respond to treatment. In the remaining 18 patients Rhizotomy was successful at 3 months follow-up. Mean VAS score before procedures was 8.85 (range 7–10), after treatment 3.8 (range 0–10).

Conclusion: Pulsed RF treatment is a safe, simple procedure to control radicular, neuropathic pain in the cervical, thoracic and lumbar regions. Advantages of this method:

It is non-destructive procedure and it can therefore be used for different indication which were not suitable for conventional RF.

Objective: To assess the safety and outcome of laminectomy in patients with spinal stenosis operated at the age of 65 years or older. The relation between the duration of the symptoms and results was investigated.

Study Design: A retrospective chart analysis with up to 10 years follow-up.

Setting: The Spinal Care Unit, Meir Medical Center, Kfar Saba, Israel.

Material and Methods: The medical records of all patients who had laminectomy for spinal stenosis at the age of 65 or more in a 10 years period were reviewed. Assessment of pain, ability to perform the basic activities of daily living, transferring dressing and basing before and after the operation was done by a telephone interview. Patient’s self-estimation of the final result of the surgery was also recorded.

Results: Two hundred eight-three patients were eligible to participate in the study.

They were allocated into 3 groups according to the duration of symptoms before surgery. Group A with symptoms lasting up to 24 months, B with 25–48 months and C with symptoms lasting for more than 48 months. The average age at the time of the operation was 68.9, 72.6 and 71.3 years, respectively. Forty-eight patients died and 18 refused or were not able to participate in the study. The average time of follow-up was 43.3 months, 42.2 in group A, 47.4 in B and 42.8 in C.

No significant differences were noticed in the demographic, anesthetic and surgical parameters among the 3 groups.

There were no mortality cases in the immediate postoperative period. The overall complication rate was 43.5%, nearly identical in all 3 groups. Two patients had cerebrovascular accident and 5 had myocardial ischemia but no one turned into infarction. Mild complications included 11 urinary retention, 24 urinary tract infections and 11 patients with superficial wound infection. Twenty-two patients were re-operated along the follow-up period.

There was remarkable improvement in the perception of pain, walking distances and in the ability to perform basic activities of daily living in all 3 groups. Self-assessment of the final results disclosed 70% satisfied patients in group A, 67% in B and 67% in C.

Conclusion: Surgery for spinal stenosis in elderly patients is safe and often lead to significant relief of pain and improvement in the quality of life. Delaying surgery had no deleterious effect on the operative results.

Study Design: We describe innovative minimally invasive Israeli made Expandable Spinal Fusion System for lumbar spinal fusion, in patients with all caused of mechanical back pain: Degenerative Disc Disease (DDD) at one or two levels from L2–S1, up to Grade l spondylolysthesis. The purpose of the study was to provide a preliminary evaluation of the safety and efficacy of the Expandable Spinal Fusion System in establishing vertebral stability and fusion, and in improving the quality of life of the patients.

The relatively large diameter of currently used cages dictates extensive manipulations, damaging structures that are crucial for spinal stability.

The Expandable Spinal Fusion System, is 5 mm in diameter in closed configuration, applied in a minimally invasive technique, through a 6mm entering opening by an open or percutaneous posterior procedures. Once in position, its dimensions are increased to a precut size in a controlled procedure. Thus, this system maintains the integrity of facet joints, with no or minimal laminectomy, and minimal damage to the surrounding tissues.

Methods: Data were collected in a series of 60 patients with DDD in levels L3–S1. The patients wee operated in the open posterior approach with or without Pedicle Screws and percutaneous posterolateral. Both end-plates faces were treated by special curettes and partially removed. Posterior iliac bone graft was used and 2 tubes device were introduced to the inter-somatic space under direct vision controlled by X-rays C-Arm intensifying magnification.

Data: The implantation approach was posterior in 52 patients, anterior in 2 and percutaneous in 6 patients. Maximal follow up period is 12 months. Patients follow up was completed according to investigational protocol mandate follow up visit at 1.5, 3, 6, 12 months postoperatively. The main at the time of the surgery was 52 years old. 57 underwent surgery at one level as follows: 3 at L3-L4, 32 at L4-L5, and 21 at L5-S1, and 3 underwent surgery at two levels.

Patient questionnaire pain and quality of life was evaluated using the Oswestry questionnaire and VAS measurement. The patient fill those pre-operatively and at each follow up visit.

Results: Although follow up period is short according to preliminary data, the Expandable Spinal Fusion System has proved to be safe, effective, as well as easy to handle for treating all cases of mechanical back pain: DDD. There was no neurological injury, no infection, no death and no worsening of clinical symptoms. There was no breakage or migration of the implant at the last follow-up. Flexion-Extension X-ray show good stability. VAS score for pain dropped from 8 pre op to 2.6 in average 3 months post-op.