Purpose and background. Acute and chronic spinal pain are major causes of disability, and many patients use analgesics to treat their pain. However, increased use of analgesics, particularly prescription opioids have the potential to be overused and cause dependence. Psychological factors such as stress, anxiety, depression, pain acceptance, pain catastrophising and alexithymia influence both the pain response and analgesic use, yet to date no studies have explored these variables in spinal pain patients. Therefore, the aim of this study is to assess the nature, prevalence and correlates of analgesic dependence among patients with acute or chronic spinal pain. Methods and results. Patients over the age of 18 attending outpatient services at the Royal Derby Hospital with complaints of either acute or chronic spinal pain and currently using analgesics to treat their pain completed the Current Opioid Misuse Measure, the Depression, Anxiety and Stress Scale-21, the Chronic Pain Acceptance Questionnaire-8, the Pain Catastrophising Scale, the Toronto Alexithymia Scale-20, and the Leeds Dependence Questionnaire, a measure of analgesic dependence. Preliminary findings from 52 patients (16 males and 36 females) with chronic spinal pain ranging from 23–88 years old, show that greater pain catastrophising is a significant predictor of analgesic dependence (t = 2.74, df = 51, p = 0.009). Conclusion. The study findings can inform the development of appropriate interventions targeting pain catastrophising to prevent and/or treat analgesic dependence, as well as contributing to potential future research on the understanding of
The widespread use of MRI has revolutionised
the diagnostic process for spinal disorders. A typical protocol
for spinal MRI includes T1 and T2 weighted sequences in both axial
and sagittal planes. While such an imaging protocol is appropriate
to detect pathological processes in the vast majority of patients,
a number of additional sequences and advanced techniques are emerging.
The purpose of the article is to discuss both established techniques
that are gaining popularity in the field of spinal imaging and to
introduce some of the more novel ‘advanced’ MRI sequences with examples
to highlight their potential uses. Cite this article:
We carried out a prospective study to determine whether the addition of a recombinant human bone morphogenetic protein (rhBMP-2) to a machined allograft spacer would improve the rate of intervertebral body fusion in the spine. We studied 77 patients who were to undergo an interbody fusion with allograft and instrumentation. The first 36 patients received allograft with adjuvant rhBMP-2 (allograft/rhBMP-2 group), and the next 41, allograft and demineralised bone matrix (allograft/demineralised bone matrix group). Each patient was assessed clinically and radiologically both pre-operatively and at each follow-up visit using standard methods. Follow-up continued for two years. Every patient in the allograft/rhBMP-2 group had fused by six months. However, early graft lucency and significant (>
10%) subsidence were seen radiologically in 27 of 55 levels in this group. The mean graft height subsidence was 27% (13% to 42%) for anterior lumbar interbody fusion, 24% (13% to 40%) for transforaminal lumbar interbody fusion, and 53% (40% to 58%) for anterior cervical discectomy and fusion. Those who had undergone fusion using allograft and demineralised bone matrix lost only a mean of 4.6% (0% to 15%) of their graft height. Although a high rate of fusion (100%) was achieved with rhBMP-2, significant subsidence occurred in more than half of the levels (23 of 37) in the lumbar spine and 33% (6 of 18) in the cervical spine. A 98% fusion rate (62 of 63 levels) was achieved without rhBMP-2 and without the associated graft subsidence. Consequently, we no longer use rhBMP-2 with allograft in our practice if the allograft has to provide significant structural support.
