Background and purpose of study:.
Background.
Background:
Purpose. Back pain is the primary cause of disability worldwide yet surprisingly little is known of the underlying pathobiology. We conducted a genome-wide association study (GWAS) meta-analysis of
Aim: The evaluation of the reliability of the Oswestry disability questionnaire in postmenopausal women with osteoporosis and
Percutaneous radiofrequency facet joint denervation (RFJD) has been used increasingly since being described by Shealy1 for the non-surgical treatment of chronic low back pain. Extensive literature exists on this technique with a number of randomised control studies suggesting efficacy against Placebo2,3. However, the efficacy and reliability of repeat RFJD for
Chronic low back pain (cLBP) is a complex, multifaceted disorder where biological, psychological, and social factors affect its onset and trajectory. Consequently, cLBP encompasses many different disease variants, with multiple patient-specific mechanisms. The goal of NIH Back Pain Consortium (BACPAC) Research Program is to develop understanding of cLBP mechanisms and to develop algorithms that optimally match specific treatments to individual patients. To accomplish this, one research activity of BACPAC is to develop theoretical models for chronic low back pain based on the current state of knowledge in the scientific community, and to interrogate the relationships implied by the theoretical models using data generated by or available to BACPAC. The models consider biopsychosocial perspectives, and encompass both peripheral (i.e. low back) and central (i.e. spinal and supra-spinal) factors as well as proposed mechanisms of action of cLBP treatments. However, absent explanations, models/algorithms may fall short of regulatory requirements and clinician expectations, and ultimately may not be embraced by physicians and patients. To address this, BACPAC is developing a clinical utility roadmap (CUR) to clarify how models will be used in practice for selecting optimal treatments, monitoring response to treatment, and reducing health care utilization. This presentation will review the goals of BACPAC and how theoretical models and CUR are being used to support computational knowledge networks to integrate data from deeply phenotyped cLBP patients.
Purpose of the study: To determine the results three to four years after a multidisciplinary programme for people with long-standing absenteeism due to
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The procedure involves, at each segment, cephalad and caudad pedicle screws connected with a polycarbourethane spacer and polyethylene cord. It achieves load relief and controlled flexion. Since 1996, 7000 procedures have been undertaken globally.
Where root compression was present, a midline approach and posterior screw placement was used in conjunction with open decompression. With back pain alone a bilateral Wiltse approach and posterolateral placement was used. All patients were assessed pre and post surgery with SF36, Oswestry Disability Index and pain analogue scores and modified Zung. Standing radiographs were obtained post surgery and at review. Follow up was at 6, 12, 24 and 52 weeks in addition to this review.
The present series is early, but gives grounds for encouragement. Screw loosening and failure are technical problems detracting from the result and require further development. We are continuing to use the technique.
INTRODUCTION: We report a series of 90 patients enrolled in a prospective study of Dynesys stabilisation reviewed at 12 to 30 months. The procedure involves, at each segment, cephalad and caudad pedicle screws connected with a polycarbo-urethane spacer and polyethylene cord. It achieves load relief and controlled flexion. Since 1996, 7000 procedures have been undertaken globally. METHOD: Indications are analogous to consideration for fusion. Entry criteria included (1) unresolved and unacceptable lumbar back pain despite protracted conservative management and (2) definite pathology where symptoms could be abolished by anaesthetising the target segments. Where root compression was present, a midline approach and posterior screw placement was used in conjunction with open decompression. With back pain alone a bilateral Wiltse approach and posterolateral placement was used. All patients were assessed pre- and post-surgery with SF36, Oswestry Disability Index and pain analogue scores and Modified Zung. Standing radiographs were obtained post- surgery and at review. Follow-up was at six, 12, 24 and 52 weeks in addition to this review. RESULTS: Follow-up was 100%. 89 patients survived. Mobilisation was achieved on day 1 and discharge usually by day 2. Based on the above outcome measures and patient satisfaction good to excellent results were achieved in 74% (66/89). Screw loosening or breakage occurred in 8%, and was associated with a poor result. DISCUSSION: Dynesys flexible stabilisation offers a simple alternative to fusion with less potential for adjacent ‘Domino’ failure. It differs from tension ligament systems such as Graf. At this stage the results appear at least as good as a comparable cohort of fusion patients. The present series is early, but gives grounds for encouragement. Screw loosening and failure are technical problems detracting from the result and require further development. We are continuing to use the technique.
Introduction of new surgical intervention need assessment of the true results by eliminating cognitive dissonance and the placebo effect. Significant time must elapse since the procedure to derive conclusions. With the initial gratifying results of Endoscopic Foraminoplasty a retrospective analysis of the data was performed to identify if the outcome was accurate and not a placebo effect. Early postoperative Data (6 weeks and 6 months) derived from questionnaires on 91 patients with Endoscopic Foraminoplasty (April 1997 and November 1998), which included the Oswestry Disability Scale and a Visual Analogue Pain Scale was compared with the data at 2 years (late). A t-test was used to assess the difference between the Oswestry Disability scores from the two questionnaires and a Wilcoxon Signed Rank test for the Visual Analogue Pain Scale. No significant difference between the Visual Analogue Pain Scores at 6 weeks to 6 months and 2 years post-operation was noted. There was however, a marginal improvement (p= 0.05) in Oswestry Index over two years period. The initial outcome of Endoscopic Laser Foraminoplasty was sustained or improved at the end of two years and was not a placebo effect.
The view that patients low back pain presenting with ‘abnormal’ psychometric and poor DRAM scores predict an unsatisfactory surgical outcome is considered controversial. This prospective study was designed to identify if DRAM Scores (Scores of Distress Risk Assessment Method) is a predictive determinant or a reactive instrument in regard to the outcome of Endoscopic Foraminoplasty. One hundred and eighty-five patients (86 males and 99 females) underwent an Endoscopic Laser Foraminoplasty between April 1997 and November 1998. Pre- and postoperative assessment at 2 years was made using the Oswestry Disability Scale, and the Visual Analogue Pain Scale and the DRAM scores. Patients were categorised by their pre-op DRAM score. A Kruskal-Wallis analysis of variance and a regression analysis were performed. There was significant improvement in disability and pain scores at two years. (p<
0.05). A significant difference in median DRAM between the preoperative and postoperative score at two years was noted. While the DRAM score predicted the patients’ disability and pain it failed to predict the change in outcome. The DRAM score highlights individuals in distress who may need psychological support and physical treatment for optimum benefit from endoscopic spinal intervention and not be used to deny a surgical intervention.
Tryfonidou leads the Horizon 2020 consortium (iPSpine; 2019–2023) bringing a transdisciplinary team of 21 partners together to address the challenges and bottlenecks of iPS-based advanced therapies towards their transition to the clinic. Here,
Purpose. Cognitive Muscular Therapy (CMT) is a new treatment for low back pain which integrates psychological techniques for pain management alongside training to improve postural control. Rather than focus on postural alignment or strength, CMT aims to improve the regulation of postural tone (low-level activity which supports the body against gravity). This is achieved by teaching patients an awareness of compensatory paraspinal activation, which can be triggered by overactivity of the abdominal muscles. The aim of this study was to understand whether CMT could reduce symptoms associated with low back pain and improve paraspinal muscle activation. Methods and results. Fifteen patients with chronic low back pain received seven weekly sessions of CMT from a physiotherapist. Clinical data was captured at baseline and two weeks after the intervention using the Roland-Morris questionnaire and the pain catastrophising scale. Activation of the erector spinae muscle during walking was also measured at baseline and after the final intervention session. Change data were analysed using paired t-tests. There was a 75% reduction (p<0.001) in the Roland-Morris score from a mean (SD) of 9.3(2.9) to 2.3(2.6), along with a 78% reduction in pain catastrophising (p<0.002) from 16.6(13) to 3.7(4.8). Activation of the contralateral erector spinae muscles reduced by 30% (p<0.01) during the contralateral swing phase of walking. Conclusion. In this small sample, CMT delivered large clinical improvements and reduced activation of the low back muscles during walking. Larger randomised trials are now required to confirm whether CMT could outperform existing physiotherapy treatments for
Intervertebral disc (IVD) degeneration is responsible for severe clinical symptoms including
Background. Lateral lumbar spine statistical shape models (SSM) have been used previously to describe associations with osteoarthritis and back pain. However, associations with factors such as osteoporosis, menopause and parity have not been explored. Methods and Results. A 143-point SSM, describing L1 to the top of L5, was applied to lateral spine iDXA scans from UK Biobank. Associations with self-reported osteoporosis, menopause, parity and back pain and the first 10 modes of variation were examined using adjusted binary logistic regression or linear regression (adjusted for age, height, weight and total spine BMD). We report odds ratios with 95% confidence intervals for each standard deviation change in mode. Complete data were available for 2494 women. Mean age was 61.5 (± 7.4) years. 1369 women reported going through menopause, 96 women self-reported osteoporosis and 339 women reported