Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome?

Study Design: Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above.

Objective: To assess the influence of education level on outcomes for treatment of lumbar disc herniation.

Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: results from the Spine Patient Outcomes Research Trial (SPORT).

Study Design: As-treated analysis of the Spine Patient Outcomes Research Trial.

Objective: To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e.

Spine patient outcomes research trial: radiographic predictors of clinical outcomes after operative or nonoperative treatment of degenerative spondylolisthesis.

Study Design: Subgroup analyses according to treatment received.

Objective: To evaluate whether baseline radiographic findings predicted outcomes in patients with degenerative spondylolisthesis.

Summary Of Background Data: The spine patient outcomes research trial combined randomized and observational DS cohorts.

Lumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial.

Background: The Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed subgroups within the Spine Patient Outcomes Research Trial to assess the effect of herniation level on outcomes of operative and nonoperative care.

Methods: The combined randomized and observation cohorts of the Spine Patient Outcomes Research Trial were analyzed by actual treatment received stratified by level of disc herniation.

SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter?

Study Design: Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort.

Objective: This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes.

Summary Of Background Data: Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes.

Physician-patient communication: a lost art?

In the face of rapid advances in technology, there has been a progressive deterioration of effective physician-patient communication. The American Academy of Orthopaedic Surgeons has identified that patients rate the orthopaedic profession as high in technical and low in communication skills. Poor communication, especially patient-interviewing skills, has been identified in medical students as well as in practicing physicians.

Hip osteotomy arthroplasty: ten-year follow-up.

We previously reported the initial success of combined osteotomy and arthroplasty of the hip for arthritis with femoral deformity. This technique has gained acceptance. We now report, for the first time, the ten year clinical and radiographic results with histology of 2 specimen.

Workers' Compensation and return-to-work in low back pain.

The relationship of Workers' Compensation and litigation to low back pain (LBP) outcome is not established in the literature. Our study investigated the characteristics of disabled persons applying for Worker's Compensation or employing a lawyer, the factors predicting receipt of compensation, and the effects of compensation and litigation on employment outcome. One hundred sixty-nine unemployed persons with LBP were assessed by medical history, physical exam, biomechanical testing, psychiatric interview, and MMPI.

The use of expanded polytetrafluoroethylene as an interpositional membrane after lumbar laminectomy.

Study Design: Prevention of post-laminectomy membrane formation was evaluated in a canine model. Fat graft, Silastic sheeting and expanded polytetrafluoroethylene were compared with nonimplanted control sites.

Objectives: The development of an effective barrier to peridural scar invasion is of major importance in optimizing results after lumbar laminectomy.

L4-5 isthmic spondylolisthesis. A biomechanical analysis comparing stability in L4-5 and L5-S1 isthmic spondylolisthesis.

The authors have previously reported that the L4-5 isthmic spondylolisthesis lesion often progresses more than the L5-S1 lesion in adult patients. This biomechanical study compares the in vitro stability of the L4-5 isthmic spondylolisthesis lesion compared with the L5-S1 isthmic lesion. The authors also analyzed the role of the L5 iliolumbar ligament as a contributing factor to stability.

Degenerative Spondylolisthesis: Diagnosis and Treatment.

Degenerative spondylolisthesis is most often seen at the L4-5 level. The most common complaint is back pain, but the advent of leg symptoms, such as claudication and restless legs syndrome, is often the reason for seeking specialized medical attention. Conservative treatment usually suffices; extended bed rest is of little value.

An international challenge to the diagnosis and treatment of disorders of the lumbar spine.

Since its formation 20 years ago, the International Society for Study of the Lumbar Spine has stimulated basic and clinical research. Because few disorders of the lumbar spine are lethal, our usual goal is to improve the quality of life of our patients by relieving pain and improving function. To do so, we must continuously improve the quality of the preventive, diagnostic, and treatment methods we employ.

Thermography as a diagnostic aid in sciatica.

Thermography has been proposed as a diagnostic aid in patients with sciatica. Supporters of thermography state that: (a) normal patients have normal thermograms of their lower extremities, and (b) abnormal patients (with disk ruptures causing sciatica) have abnormal thermograms. To test these two hypotheses, 56 patients with clinically documented acute sciatica, with a supporting diagnostic study [computed tomography (CT), CT/myelography, and/or magnetic resonance imaging] showing a ruptured disk, had presurgical thermograms.

Diagnosing instability.

The various definitions of instability are reviewed and preference is given to the definition of instability as a loss of stiffness. This definition fits with current laboratory observations. Roentgenographic changes, particularly those associated with degeneration, have no relationship to instability.

Predicting disability from low back pain.

Since World War II, the incidence of chronic low back disability has increased dramatically, at a rate disproportionate to all other health conditions. The factors that contribute to this disability are reviewed. Psychosocial and work environmental factors are far more accurate predictors of disability than physical factors.

Lumbar disk disease: epidemiology.

Sciatica is a common symptom that affects as many as 40% of the adult population at some time. However, clinically significant sciatica is much less common and occurs in only 4% to 6% of the population. Exactly how often the symptom is caused by lumbar disk herniation is uncertain; it is known that herniation can occur independent of symptoms.

Low back pain. The role of spine fusion.

The major objectives of spinal surgery are to relieve pain, improve function, and correct deformity. The surgical strategies to meet these objectives are decompression of neural elements or surgical stabilization by arthrodesis. This article analyzes spinal fusion from the perspective of indications, the broad principles of surgical technique, the results that can be obtained, and the complications of the procedure.

Clinical tests applicable to the study of chronic low-back disability.

This symposium has evaluated the possible directions to be taken in designing reliable and valid questionnaires, screening examinations, and paraclinical tests applicable to studies in LBP. The detailed design of such test instruments, field testing, measures of reliability, and validity represent the next step if the current barriers to collaborative clinical research in LBP are to be overcome.